Full Visualization of Contact Endoscopy for Basal Ganglia Hemorrhage: A Multicenter Retrospective Study Comparing With Microscopy and Neuroendoscopy

BACKGROUND: Basal ganglia hemorrhage (BGH) is a severe subtype of spontaneous intracerebral hemorrhage. Surgical intervention remains a critical strategy for reducing hematoma volume, alleviating mass effect, and improving clinical outcomes. This study compared fully visualized contact endoscopy with microscopy and standard neuroendoscopy for BGH treatment. METHODS: A retrospective, multicenter, observational cohort study was conducted on patients undergoing surgical evacuation for BGH (n=335) at 8 tertiary medical centers in Suzhou from January 2021 to May 2024, stratified into microscopy (n=217), neuroendoscopy (n=76), and contact endoscopy (n=42) groups. Surgical outcomes and prognostic indicators were systematically evaluated across groups, with multivariable analysis conducted to independently assess the impact of surgical methods on long-term prognosis. RESULTS: Both endoscopic groups showed significantly shorter operation times, reduced blood loss, and shorter intensive care unit stays than the microscopy group ( P <0.05), with no difference between endoscopic techniques. Endoscopy was associated with lower intracranial infection rates ( P <0.0167). There were no significant differences in hematoma evacuation rates, neurological scores at 7 days, or functional outcomes (both Glasgow Outcome Scale scores and Karnofsky Performance Status scores) at 3 months. Multivariable analysis identified older age, hypertension, and larger hematoma volume, but not surgical technique, as independent predictors of poor long-term outcome. CONCLUSIONS: Microscopy, neuroendoscopy, and contact endoscopy all demonstrated effectiveness for hematoma evacuation and life preservation for BGH. Endoscopic approaches may offer superior perioperative safety profiles without significant long-term outcome differences. Contact endoscopy is a safe and feasible alternative for BGH surgery.