Comparison of Neurofactor Changes and Prognosis in Elderly Patients with Spontaneous Intracerebral Hemorrhage Treated with Endoscopic versus Conventional Craniotomy Surgery

Chao Lei,1,2 Chong Li,1,2 Xing Chen,1,2 Gaosheng Zhou,1,2 Xiaxia Zheng,1,2 Zhaohui Zhang,1,2 Xingguang Qu1,2 1Department of Critical Care Medicine, The First College of Clinical Medical Science, China Three Gorges University, Yichang, People’s Republic of China; 2Department of Critical Care Medicine, Yichang Central People’s Hospital, Yichang, People’s Republic of ChinaCorrespondence: Xingguang Qu, Email [email protected] Zhaohui Zhang, Email [email protected]: To compare the clinical efficacy, neurofactor changes, and prognosis in elderly patients with spontaneous intracerebral hemorrhage (ICH) treated with endoscopic surgery versus conventional craniotomy.Methods: A retrospective analysis was conducted on 88 elderly patients with spontaneous ICH admitted from July 2021 to April 2024. Based on surgical method, patients were assigned to either the conventional craniotomy group (n=44) or the endoscopic surgery group (n=44). Surgical efficacy (hematoma evacuation rate, surgical duration, intraoperative blood loss), short-term prognosis (ICU stay, hospital stay, GOS, NIHSS, ADL scores), serum neurofactors (SOD, NSE, NGF, BDNF), inflammatory markers (WBC, CRP, PCT), and complication rates were compared.Results: (1) The endoscopic group had significantly shorter surgical time and lower blood loss than the craniotomy group (P< 0.05), with similar hematoma evacuation rates (P> 0.05). (2) ICU and hospital stays were significantly shorter in the endoscopic group (P< 0.05). Postoperative GOS and ADL scores were higher, and NIHSS scores were lower in the endoscopic group at 3 months (P< 0.05). (3) Compared with preoperative levels, both groups showed a decreasing trend in SOD and NSE and an increasing trend in NGF and BDNF after surgery, with the observation group showing more significant and sustained changes over time (P < 0.05). (4) Although postoperative inflammatory markers increased in both groups, the observation group had milder elevations and faster downward trends (P < 0.05). (5) The complication rate was lower in the endoscopic group (6.82% vs 22.73%, P< 0.05).Conclusion: Compared to conventional craniotomy, endoscopic hematoma evacuation in elderly ICH patients results in milder inflammatory responses, more favorable neurofactor changes, fewer complications, and improved recovery. However, these findings require further validation due to the retrospective design and limited sample size.Keywords: spontaneous intracerebral hemorrhage, elderly, endoscopic surgery, neurofactors, prognosis