Successful endoscopic evacuation of traumatic intracerebral hemorrhage: A report of two cases

Background: Traumatic intracerebral hemorrhage (TICH) often coexists with other traumatic intracranial lesions and presents complex pathophysiology, making surgical decision-making challenging. Although craniotomy has long been the standard treatment for space-occupying traumatic hematomas, endoscopic hematoma evacuation has emerged as a minimally invasive alternative. However, evidence supporting its application to TICH remains limited. Case Description: We report two patients with TICH who underwent endoscopic hematoma evacuation for acute traumatic management. In both cases, neurological deterioration was attributed to the localized mass effect caused by traumatic intracerebral hematomas, and endoscopic evacuation was selected to achieve focal decompression. The procedures were performed through burr holes using a transparent sheath and rigid neuroendoscope. Adequate hematoma removal was achieved without intraoperative or postoperative hemorrhagic complications. Postoperative computed tomography confirmed satisfactory evacuation, and intracranial pressure was well controlled during the acute phase. Although both patients ultimately died from nonneurological causes, no TICH-related neurological deterioration was observed during the postoperative course. Conclusion: Endoscopic hematoma evacuation may represent a technically feasible minimally invasive option for achieving focal decompression in selected patients with TICH. In the present two cases, adequate hematoma removal was achieved without procedure-related complications. However, because both patients ultimately died from severe systemic comorbidities unrelated to the neurosurgical procedure, no conclusions can be drawn regarding the effect of this technique on overall survival or long-term neurological outcomes. Further studies are required to establish appropriate surgical indications and determine their clinical benefit.