Optimized Endoscopic Hemostasis in Spontaneous Intracerebral Hemorrhage: A Pilot Study of the "Chopsticks" Technique

Endoscopic evacuation for spontaneous intracerebral hemorrhage can limit approach-related injury, but hemostasis and visualization within a narrow corridor remain challenging. We evaluated whether a single-surgeon "chopsticks" configuration was associated with improved operative efficiency and early neurological recovery compared with a conventional 2-surgeon, 3-handed technique.

We performed a single-center retrospective cohort study of supratentorial spontaneous intracerebral hemorrhage treated with endoport-assisted endoscopic evacuation (control, n = 25; chopsticks, n = 20) after excluding structured training-phase cases. Primary outcomes were operative time and estimated blood loss. Early neurological recovery (secondary outcome) was assessed using the Full Outline of UnResponsiveness (FOUR) score on postoperative day 3 (D3) and day 7 (D7); ΔFOUR was defined as FOUR_D7 - FOUR_D3. Other outcomes were exploratory.

Baseline characteristics were similar between groups. Operative time was shorter with the chopsticks configuration (118.3 ± 14.8 vs 147.3 ± 52.9 minutes; P = .014), and estimated blood loss was lower (100.5 ± 30.1 vs 184.0 ± 117.1 mL; P = .002). Radiographic evacuation efficacy was high in both groups with similar evacuation rate and residual hematoma volume. FOUR improved more from D3 to D7 in the chopsticks group (median [IQR] 3.0 [2.0-3.2] vs 2.0 [1.0-3.0]; P = .005). In an intracerebral hemorrhage score-adjusted linear mixed-effects model, the group × time interaction was significant (β = 1.01; 95% CI 0.42-1.60; P = .001).

In this pilot cohort, the chopsticks configuration was associated with improved operative efficiency and a steeper early neurological recovery trajectory without differences in gross evacuation extent. Prospective validation is warranted.