{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:36:18Z","timestamp":1775032578519,"version":"3.50.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intraparenchymal hemorrhage (IPH) involving the cerebrum, cerebellum, and brainstem is a critical condition with high mortality. While minimally invasive surgical techniques are widely utilized, the comparative effectiveness of neuroendoscopic surgery (NS) vs. stereotactic aspiration (SA) across different anatomical locations remains underexplored. This study aims to retrospectively compare the effectiveness and safety of NS and SA in a cohort encompassing different IPH locations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A single-center retrospective analysis was conducted on 199 patients with IPH (NS:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200997; SA:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009102) treated between 2019 and 2023. The primary outcome was the median hematoma reduction rate (%) and included acute neurological improvement [change in Glasgow Coma Scale (GCS) at 24\u2005h postoperatively]. Secondary outcome: functional independence [modified Rankin Scale (mRS) 0\u20133] at discharge. Multivariate logistic regression adjusted for baseline imbalances in age and hypertension. Radiologic evacuation and neurological change were evaluated as early surrogate endpoints and do not directly measure long-term functional recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, NS demonstrated a significantly higher median hematoma reduction rate compared to SA (92.90% vs. 22.20%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and greater acute neurological improvement (median \u0394GCS 4.0 vs. 0.5 points,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). These trends were consistently observed across deep-seated, lobar, cerebellar, and brainstem subgroups (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). Functional independence at discharge was achieved by 27.8% in the NS group vs. 15.7% in the SA group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040). Furthermore, NS was associated with significantly lower symptomatic rebleeding (7.2% vs. 24.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and 30-day mortality (9.3% vs. 22.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This retrospective analysis suggests that NS is associated with higher evacuation efficiency and more pronounced early neurological recovery across various IPH locations compared to SA. While prospective validation is required to confirm long-term functional trajectories, these findings highlight the potential advantages of direct visualization and active hemostasis in managing IPH across different anatomical locations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1782293","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:42:51Z","timestamp":1775022171000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of neuroendoscopic surgery and stereotactic aspiration for brain hemorrhage"],"prefix":"10.3389","volume":"13","author":[{"given":"Hazrat","family":"Jalal","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Renmin Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huikai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Renmin Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Long","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Renmin Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Renmin Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiajun","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Renmin Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shenqi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Renmin Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiang","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Renmin Hospital of Wuhan University","place":["Wuhan, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s13054-020-2749-2","article-title":"Surgery for spontaneous intracerebral hemorrhage","volume":"24","author":"De Oliveira Manoel","year":"2020","journal-title":"Crit Care"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e8435","DOI":"10.1097\/MD.0000000000008435","article-title":"Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage","volume":"96","author":"Cai","year":"2017","journal-title":"Medicine"},{"key":"B3","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.wneu.2024.10.107","article-title":"Advancements of endoscopic surgery for spontaneous intracerebral hemorrhage","volume":"193","author":"Ma","year":"2025","journal-title":"World Neurosurg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"919","DOI":"10.2147\/NDT.S195275","article-title":"Minimally invasive evacuation of spontaneous supratentorial intracerebral hemorrhage by transcranial neuroendoscopic approach","volume":"15","author":"Cai","year":"2019","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e90","DOI":"10.1016\/j.wneu.2018.05.170","article-title":"Surgical evacuation of spontaneous cerebellar hemorrhage: comparison of safety and efficacy of suboccipital craniotomy, stereotactic aspiration, and thrombolysis and endoscopic surgery","volume":"117","author":"Li","year":"2018","journal-title":"World Neurosurg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s12975-020-00827-8","article-title":"Comparison of long-term outcomes of endoscopic and minimally invasive catheter evacuation for the treatment of spontaneous cerebellar hemorrhage","volume":"12","author":"Li","year":"2021","journal-title":"Transl Stroke Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"123487","DOI":"10.1016\/j.wneu.2024.11.070","article-title":"3-Dimensional technology-assisted minimally invasive surgery for the treatment of primary brainstem hemorrhage: a prospective cohort study","volume":"194","author":"Wei","year":"2025","journal-title":"World Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1055\/s-0044-1791713","article-title":"Neuroendoscopy training","volume":"20","author":"Hedaoo","year":"2025","journal-title":"Asian J Neurosurg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1007\/s12028-022-01634-9","article-title":"Outcomes after endoscopic evacuation versus evacuation using craniotomy or stereotactic aspiration for spontaneous intracerebral hemorrhage: analysis using a Japanese nationwide database","volume":"38","author":"Tahara","year":"2023","journal-title":"Neurocrit Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1186\/s13063-017-2041-1","article-title":"Comparison of endoscopic evacuation, stereotactic aspiration and craniotomy for the treatment of supratentorial hypertensive intracerebral haemorrhage: study protocol for a randomised controlled trial","volume":"18","author":"Xu","year":"2017","journal-title":"Trials"},{"key":"B11","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1186\/s12916-024-03468-y","article-title":"Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage (MISICH): a multicenter randomized controlled trial","volume":"22","author":"Xu","year":"2024","journal-title":"BMC Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1055\/s-0041-1726865","article-title":"Surgery for spontaneous intracerebral hemorrhage: current concept","volume":"10","author":"Ray","year":"2021","journal-title":"Indian J Neurosurg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2023\/2266691","article-title":"The application effect of craniotomy through transsylvian rolandic point-insular approach on hypertensive intracerebral hemorrhage in posterior basal ganglia","volume":"2023","author":"Wang","year":"2023","journal-title":"Behav Neurol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1016\/S0140-6736(19)30195-3","article-title":"Minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label phase 3 trial with blinded endpoint","volume":"393","author":"Hanley","year":"2019","journal-title":"Lancet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/S0140-6736(05)17826-X","article-title":"Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): a randomised trial","volume":"365","author":"Mendelow","year":"2005","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1136\/jnis-2025-023941","article-title":"Minimally invasive intracerebral hematoma evacuation: a difficult road, but a bright future","volume":"17","author":"Mascitelli","year":"2025","journal-title":"J Neurointerv Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"514","DOI":"10.62713\/aic.3950","article-title":"Comparative analysis of neurological function and prognosis after stereotactic aspiration and neuroendoscopic surgery for hypertensive intracerebral hemorrhage","volume":"96","author":"Guo","year":"2025","journal-title":"Ann Ital Chir"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e585","DOI":"10.1016\/j.wneu.2024.04.132","article-title":"Neuroendoscopic surgery versus stereotactic aspiration in the treatment of supratentorial intracerebral hemorrhage: a meta-analysis","volume":"187","author":"Sun","year":"2024","journal-title":"World Neurosurg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.wneu.2024.01.162","article-title":"Endoscopic surgery versus stereotactic aspiration in spontaneous intracerebral hemorrhage treatment: a systematic review and meta-analysis","volume":"184","author":"Yang","year":"2024","journal-title":"World Neurosurg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/JS9.0000000000004491","article-title":"Neuroendoscopy for acute severe neurological conditions: high hematoma clearance and rapid recovery in 815 patients \u2013 cohort study","volume":"111","author":"Shafiq","year":"2025","journal-title":"Int J Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2973","DOI":"10.1002\/sim.5403","article-title":"Biomarkers and surrogate endpoints in clinical trials","volume":"31","author":"Fleming","year":"2012","journal-title":"Stat Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1161\/STROKEAHA.119.026791","article-title":"National institutes of health stroke scale: an alternative primary outcome measure for trials of acute treatment for ischemic stroke","volume":"51","author":"Chalos","year":"2020","journal-title":"Stroke"},{"key":"B23","doi-asserted-by":"publisher","first-page":"17759","DOI":"10.1038\/s41598-025-01754-0","article-title":"Analysis of associated factors affecting hematoma evacuation rates in spontaneous intracerebral hemorrhage with stereotactic aspiration combined with catheter drainage","volume":"15","author":"Luo","year":"2025","journal-title":"Sci Rep"},{"key":"B24","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1136\/neurintsurg-2017-013719","article-title":"The stereotactic intracerebral hemorrhage underwater blood aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation","volume":"10","author":"Kellner","year":"2018","journal-title":"J Neurointerv Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1055\/a-2235-5453","article-title":"Robotic frameless stereotactic aspiration with thrombolysis for primary pontine hemorrhage: a therapeutic evaluation of a retrospective cohort study","volume":"86","author":"Xu","year":"2025","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1554187","DOI":"10.3389\/fneur.2025.1554187","article-title":"Triple sheath neuroendoscopic combination technique for managing complete intraventricular hemorrhage casting in patients with cerebral hemorrhage","volume":"16","author":"Shafiq","year":"2025","journal-title":"Front Neurol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1007\/s10143-019-01110-7","article-title":"Endoscope-assisted microsurgical evacuation versus external ventricular drainage for the treatment of cast intraventricular hemorrhage: results of a comparative series","volume":"43","author":"Di Rienzo","year":"2020","journal-title":"Neurosurg Rev"},{"key":"B28","doi-asserted-by":"publisher","first-page":"423","DOI":"10.2176\/nmc.oa.2019-0108","article-title":"Neuroendoscopic evacuation for spontaneous cerebellar hemorrhage is a safe and secure approach and may become a mainstream technique","volume":"59","author":"Atsumi","year":"2019","journal-title":"Neurol Med Chir"},{"key":"B29","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s10143-024-02492-z","article-title":"Efficacy and safety of neuroendoscopy surgery versus craniotomy for supratentorial intracerebral hemorrhage: an updated meta-analysis of randomized controlled trials","volume":"47","author":"Monteiro","year":"2024","journal-title":"Neurosurg Rev"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1056\/NEJMoa2308440","article-title":"Trial of early minimally invasive removal of intracerebral hemorrhage","volume":"390","author":"Pradilla","year":"2024","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1782293\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:42:51Z","timestamp":1775022171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1782293\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":30,"alternative-id":["10.3389\/fsurg.2026.1782293"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1782293","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1782293"}}