Endoscopic Hematoma Evacuation for Spontaneous Intracerebral Hemorrhage: A Single-Center Retrospective Analysis of 136 Consecutive Cases.

Abstract

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. 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. 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. 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.