Endoscopic evacuation of spontaneous intracerebral hemorrhage: Surgical outcomes and prognostic factors

Background: Spontaneous intracerebral hemorrhage (ICH) carries high mortality and poor functional outcomes. Open craniotomy has failed to demonstrate consistent benefit in major randomized trials. Minimally invasive endoscopic evacuation has emerged as a promising alternative. We evaluated surgical outcomes and prognostic factors following endoscopic evacuation of spontaneous ICH in a large cohort from a resource-limited tertiary center. Methods: A retrospective analysis of 106 consecutive patients undergoing endoscopic evacuation of spontaneous supratentorial and infratentorial ICH (January 2017–January 2025) was performed. Functional outcome was assessed using modified Rankin scale (mRS) at 3 and 6 months. Favorable outcome was defined as mRS ≤3. Results: Mean age was 49.3 ± 13.2 years. Capsuloganglionic hemorrhage was most common (61.3%). On univariate analysis, patients undergoing early surgery (<24 h) had higher unadjusted odds of favorable outcome (odds ratio 2.02; 95% confidence interval 1.18–3.91; p = 0.012). At 6 months, 65.1% achieved favorable mRS. Mortality was 10.4%. Tracheostomy was more frequently observed among patients with unfavorable outcome on univariate analysis. Overall complication rate was 22.6%, with low rebleeding (3.7%). Conclusion: Endoscopic evacuation is a feasible treatment modality for appropriately selected patients with spontaneous ICH. Early intervention showed higher unadjusted odds of favorable outcome in exploratory univariate analysis, whereas tracheostomy was more frequently observed among patients with unfavorable outcome. Because multivariable adjustment was not performed, these findings cannot establish independent prognostic effects and should be interpreted cautiously. Prospective studies incorporating adequate multivariable adjustment are required to confirm these observations.