Neuroendoscopy for acute severe neurological conditions: high hematoma clearance and rapid recovery in 815 patients – cohort study

Objective: To evaluate the efficacy and safety of neuroendoscopy for acute severe neurological conditions, focusing on hematoma clearance and consciousness recovery. Methods: We retrospectively analyzed 815 patients who underwent transcranial burr-hole neuroendoscopic surgery at our institution from September 2018 to June 2024 for intracerebral hemorrhage (ICH, n = 474), hemorrhagic cerebrovascular diseases (n = 248), traumatic intracranial hemorrhage (TICH, n = 78), and intraventricular hemorrhage (IVH) with acute hydrocephalus (n = 15). Outcomes included hematoma clearance (via postoperative computed tomography [CT] within 24 hours), consciousness recovery (Glasgow Coma Scale [GCS] ≥9 within 72 hours), complications, and 6-month Glasgow Outcome Scale (GOS) scores. Results: In this cohort (n = 815), mean hematoma clearance was 92.3 ± 5.1% (95% CI: 91.8–92.8). Severe complications (e.g., infection, re-bleeding, 30-day mortality) occurred in 3.7% (30/815; 95% CI: 2.5–5.2). Consciousness recovery (GCS ≥9) was achieved in 89.0% (725/815; 95% CI: 86.7–91.1) within 72 hours, and 88.6% (692/781; 95% CI: 86.2–90.7) attained GOS ≥4 at 6 months. Subgroup analyses by age, sex, and baseline severity showed consistent efficacy in hematoma clearance and consciousness recovery. Minor complications (e.g., transient fever, cerebrospinal fluid [CSF] leak) affected 3.1% (25/815; 95% CI: 2.0–4.6). Conclusion: Neuroendoscopy provides high hematoma clearance and rapid consciousness recovery with low complication rates, offering potential advantages over traditional craniotomy based on literature comparisons. Further prospective studies are needed to optimize techniques and validate long-term benefits.