Comparative effectiveness of neuroendoscopic surgery and stereotactic aspiration for brain hemorrhage

Background 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. Methods A single-center retrospective analysis was conducted on 199 patients with IPH (NS: n = 97; SA: n = 102) 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 h postoperatively. Secondary outcome: functional independence modified Rankin Scale (mRS) 0–3 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. Results Overall, NS demonstrated a significantly higher median hematoma reduction rate compared to SA (92.90% vs. 22.20%, p 0.001) and greater acute neurological improvement (median ΔGCS 4.0 vs. 0.5 points, p 0.001). These trends were consistently observed across deep-seated, lobar, cerebellar, and brainstem subgroups (all p 0.05). Functional independence at discharge was achieved by 27.8% in the NS group vs. 15.7% in the SA group ( p = 0.040). Furthermore, NS was associated with significantly lower symptomatic rebleeding (7.2% vs. 24.5%, p 0.001) and 30-day mortality (9.3% vs. 22.5%, p = 0.012). Conclusion 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.