A Single-Center Retrospective Study on Endoscopic Surgery and Craniotomy in Spontaneous Superficial Supratentorial Lobar Hemorrhages: Which Approach Yields Better Outcomes?

Abstract

We evaluated the efficacy, safety, and mortality of endoscopic surgery (ES) and craniotomy for superficial supratentorial lobar hemorrhages in this single-center retrospective study. We retrospectively analyzed 73 patients with superficial supratentorial lobar intracerebral hemorrhage treated between March 2017 and December 2023 by either ES (n = 33) or craniotomy (n = 40). Demographic, clinical, and radiological variables were compared between groups. Postoperative Glasgow Coma Scale (GCS) and 3-month modified Rankin Scale scores were assessed as postoperative outcomes, and 1-year mortality was defined as the primary endpoint. Baseline clinical characteristics, including age, gender, hypertension, and anticoagulant use, were comparable between the 2 groups. In contrast, ES was associated with more favorable early neurological recovery, reflected by higher postoperative GCS scores (12.0 ± 2.97 vs. 10.4 ± 3.46; P = 0.040). ES also demonstrated a substantially lower 1-year mortality rate compared with craniotomy (15.2% vs. 52.5%; P < 0.001). These differences remained consistent after adjusted analyses. Endoscopic evacuation of superficial supratentorial lobar hemorrhages was associated with shorter operative time, less blood loss, and higher 1-year survival compared with craniotomy despite baseline differences such as intraventricular hemorrhage and midline shift. Higher preoperative GCS and earlier surgery also predicted better outcomes. Given the retrospective design, baseline imbalances, and modest sample size, these findings should be interpreted cautiously. Larger prospective studies are needed to confirm the clinical benefits of endoscopic treatment.