Neuroendoscopic surgery shows higher hematoma reduction than stereotactic aspiration in intraparenchymal hemorrhage

This retrospective cohort study compared neuroendoscopic surgery (NS) with stereotactic aspiration (SA) for intraparenchymal hemorrhage (IPH) involving the cerebrum, cerebellum, and brainstem. The analysis included 199 patients treated at a single center between 2019 and 2023 (NS: n=97; SA: n=102). Baseline imbalances were adjusted using multivariate logistic regression.

The primary outcomes were median hematoma reduction rate and acute neurological improvement measured by change in Glasgow Coma Scale (GCS) at 24 hours postoperatively. NS demonstrated a significantly higher median hematoma reduction rate of 92.90% compared to 22.20% with SA. The study also assessed functional independence (modified Rankin Scale 0-3) at discharge as a secondary outcome.

Safety and tolerability data were not reported in the available evidence. Key limitations include the retrospective design and the use of early surrogate endpoints—radiologic evacuation and 24-hour neurological change—which do not directly measure long-term functional recovery. The study represents comparative effectiveness research showing association rather than causation.

For clinical practice, these findings suggest NS may achieve more complete hematoma evacuation in the acute setting compared to SA. However, clinicians should interpret these results cautiously given the retrospective nature, single-center setting, and lack of long-term functional outcomes. The evidence does not establish whether the observed hematoma reduction translates to improved functional independence or recovery over time.