Interdisciplinary Neurosurgery · Published 2026-06-01 · DOI 10.1016/j.inat.2026.102300
Sampad Dash, Ajay Choudhary, Manoj Kumar Agarwal
Background: Sponneous intracerebral hemorrhage (ICH) remains a devastating neurological emergency with persistently high mortality and limited effective surgical options. Minimally invasive endoscopic evacuation has emerged as a promising strategy to achieve rapid decompression while minimizing iatrogenic injury. This study evaluates the efficacy and clinical outcomes of endoscopic hematoma evacuation in patients with moderate-to-large spontaneous ICH. Methods: In this prospective observational study, 24 patients with primary ICH (>30 mL) and significant mass effect underwent endoscopic evacuation between November 2022 and December 2023. Hemorrhage location, perioperative variables, and neurological outcomes were analyzed. Functional outcomes were assessed using the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) at discharge, 1 month, and 3 months. Results: Eighteen patients (75%) had basal ganglia hemorrhage, four (16.66%) had thalamic hemorrhage, and two (8.33%) had lobar hemorrhage. The mean hematoma volume was 48.04 ± 11.02 mL. Endoscopic evacuation resulted in a marked improvement in neurological status, with significant gains in GCS eye-opening scores (2.08 ± 1.02 to 4 ± 0; p < 0.0001). The mortality rate was low (8.33%), and 27.27% of patients demonstrated functional improvement at 3 months (p = 0.011). Hemorrhage location was not significantly associated with outcome (p = 1.00). Conclusion: Endoscopic evacuation offers an effective, minimally invasive solution for spontaneous ICH, achieving meaningful neurological recovery with low mortality. In appropriately selected patients, this approach may represent a practical and scalable alternative to conventional surgery, particularly in resource-constrained settings.
Abstract from DOAJ. Public domain (CC0 1.0).
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Dash, S., Choudhary, A., Agarwal, M. (2026). Efficacy of endoscopic evacuation of spontaneous intracranial hematoma. Interdisciplinary Neurosurgery. https://doi.org/10.1016/j.inat.2026.102300