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Updated: Aug 11, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Endoscopic Hematoma Evacuation for Spontaneous Intracerebral Hemorrhage: A Single-Center Retrospective Analysis of
Atsushi Kuge1, Rei Kondo2, Tetsu Yamaki2
1Department of Emergency Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan; Stroke Center, Yamagata City Hospital Saiseikan, Yamagata, Japan.
Background:
Endoscopic hematoma evacuation is an established minimally invasive treatment for spontaneous intracerebral hemorrhage (ICH), yet real-world data encompassing diverse hemorrhage locations, elderly patients, and antithrombotic use remain limited.
Methods:
We retrospectively reviewed 136 consecutive patients who underwent endoscopic hematoma evacuation for spontaneous ICH at a single stroke center in Japan (April 2018-February 2026) using a dilated burr-hole approach with the Neuroport transparent sheath. Surgical indications followed the Japanese Stroke Society guidelines. The primary outcome was favorable functional outcome (modified Rankin Scale [mRS] 0-3) at 90 days.
Results:
Median age was 72 years (IQR: 62%-83%); 21% were on antithrombotic agents. Hemorrhage locations included putamen (43%), thalamus with IVH (18%), subcortical (15%), cerebellum (13%), isolated IVH (10%), and caudate (1.5%). Median hematoma evacuation rate was 90% (IQR: 81%-96%). Favorable outcome was achieved in 32% overall; by location: putamen 36%, cerebellum 56%, thalamus with IVH 17%, and subcortical 25%. Ninety-day mortality was 15%. No postoperative rebleeding requiring surgical intervention or re-operations occurred. In multivariate logistic regression, higher admission GCS (OR = 1.40; P = 0.004), younger age (OR = 0.95 per year; P = 0.005), smaller hematoma volume (OR 0.82 per 10 mL; P = 0.030), lower premorbid mRS (OR 0.46; P = 0.010), and non-thalamic location were independent predictors of favorable outcome.
Conclusions:
Endoscopic hematoma evacuation demonstrates high technical efficacy (median 90% evacuation) with no rebleeding or re-operations across diverse ICH locations in a real-world elderly population. These findings complement randomized trial data and support endoscopic surgery as a viable minimally invasive strategy for spontaneous ICH.
