NEUROSURGICAL INTERVENTIONS AND THEIR IMPACT ON PHYSICAL AND PSYCHOLOGICAL RECOVERY AFTER SUPRATENTORIAL HYPERTENSIVE ICH

Background: Supratentorial hypertensive intracerebral haemorrhage (HICH) remains a life-threatening condition with significant mortality and morbidity. Surgical interventions such as conventional craniotomy (CT) and neuroendoscopic surgery (NES) have been proposed to evacuate hematomas, but their comparative effectiveness is still debated. Objectives: To systematically evaluate and compare the clinical outcomes, safety, and procedural advantages of NES versus craniotomy in adult patients with supratentorial HICH. Methods: This systematic review followed PRISMA guidelines and analyzed 33 studies, including randomized controlled trials, retrospective and prospective cohort studies, and meta-analyses published from 2000 to 2025. Inclusion criteria comprised adult patients diagnosed with CT/MRI-confirmed supratentorial HICH undergoing either NES or CT. Outcomes assessed included mortality, hematoma evacuation rate, complications, functional recovery (mRS/GOS), surgical time, and ICU/hospital stay. Results: NES demonstrated significant advantages over CT in most studies, including shorter operative times, reduced blood loss, higher hematoma evacuation rates, fewer complications (especially infections), better functional outcomes, and shorter hospital/ICU stays. Mortality rates were similar across groups, but NES was associated with improved long-term prognosis and quality of life. Conclusion: NES appears to be a superior alternative to conventional craniotomy for the treatment of supratentorial HICH due to its minimally invasive nature and better perioperative and functional outcomes. Further multicentre RCTs with standardized protocols are warranted to establish NES as the first-line surgical approach.