ABSTRACT NUMBER: ESOC2026A1304 MINIMALLY INVASIVE SURGERY FOR DEEP INTRACEREBRAL HEMORRHAGE: A REAL-WORLD COHORT STUDY ADDRESSING THE EVIDENCE GAP

Abstract Background and aims Minimally invasive surgery (MIS) has shown efficacy in lobar intracerebral hemorrhage through the ENRICH trial. However, its benefits for deep ICH remain uncertain. This study aimed to evaluate the efficacy and safety of MIS guided by AI-based navigation for deep ICH, compared to standard medical management. Methods We conducted a prospective cohort study of patients with deep intracerebral hemorrhage (volume 30–80 mL) admitted within 3 days of symptom onset. Group allocation (MIS vs. standard care) was based entirely on family preference. Functional outcome was assessed at 90 days using the modified Rankin Scale (mRS). Results A total of 95 patients were included (56 MIS, 39 standard treatment). Baseline hematoma volume (40.5 ± 10.6 vs. 42.3 ± 14.1 mL; p = 0.50), admission GCS (median 12 vs. 12; p = 0.95), and NIHSS score (median 18 vs. 17; p = 0.92) were comparable between the MIS and standard treatment groups. Favorable functional outcome (mRS 0–3 at 90 days) was more frequent in the MIS group (60.7% vs. 33.3%; p = 0.009), while 90-day mortality was lower in the MIS group (0% vs. 33.3%; p < 0.001). No surgical site infections or rebleeding events were reported in the MIS group. Conclusions In patients with deep intracerebral hemorrhage, minimally invasive surgery was associated with better functional outcomes and lower mortality at 90 days compared to standard medical management. These results support the potential role of MIS in selected patients with deep ICH, but further randomized studies are warranted. Conflict of interest Huynh Quoc Huy: nothing to disclose, Nguyen Quoc Trung: nothing to disclose, Nguyen Hung Sang: nothing to disclose, Nguyen Huy Thang: nothing to disclose