Analysis of the learning curve for neuroendoscopic evacuation of basal ganglia hemorrhage

Background Neuroendoscopic evacuation has become an important minimally invasive approach for the treatment of basal ganglia hemorrhage. However, its technical complexity requires a well-defined learning curve, and evidence regarding learning curve characteristics, particularly among experienced surgeons, remains limited. Objective To evaluate the learning curve of neuroendoscopic evacuation for basal ganglia hemorrhage and to determine the number of cases required to achieve technical proficiency. Methods A retrospective analysis was conducted on 120 consecutive patients with basal ganglia hemorrhage who underwent neuroendoscopic evacuation performed by a single experienced neurosurgeon. The learning curve was assessed using cumulative sum (CUSUM) analysis based on operative time. A segmented regression model and a power-law model were applied to characterize the learning curve. Surgical outcomes, hemostasis strategies, and postoperative imaging indicators were compared across different learning phases. Results The CUSUM analysis identified a clear learning inflection point at approximately the 25th case. Operative time decreased significantly across phases (1.77 ± 0.47 h vs. 1.28 ± 0.40 h vs. 1.23 ± 0.42 h, P < 0.01), while the hematoma evacuation rate increased significantly (84.90% ± 3.59% vs. 93.27% ± 3.65% vs. 92.92% ± 3.41%, P < 0.01). Most surgical performance indicators improved significantly between the initial and proficiency phases, with no significant differences observed between the later phases, indicating performance stabilization. In addition, the use of electrocoagulation and hemostatic materials decreased significantly, accompanied by improvements in postoperative imaging indicators and a reduction in overall complication rates ( P = 0.005). Conclusion Significant differences exist in neuroendoscopic evacuation of basal ganglia hematomas across different learning phases. These findings can provide guiding value for clinicians to improve surgical efficiency and quality.