Endoscopic evacuation vs. stereotactic aspiration for the treatment of supratentorial intracerebral hematoma: A comparative study

BACKGROUND: Endoscopic surgery (ES) and stereotactic aspiration (SA) are minimally invasive surgical techniques. This study was conducted to investigate the differences between ES and SA in terms of perioperative perihematomal edema (PHE) and evaluate the relationship between perioperative PHE volumes and long-term functional dependence. METHODS: The clinical data of 199 patients with supratentorial spontaneous intracerebral hemorrhage were collected from January 2018 to August 2024, and 1:1 matching was applied using propensity scores. Confounding factors were excluded, and the final ES and SA groups each comprised 84 patients. Three-dimensional PHE volume measurements were conducted using 3D Slicer. The perioperative dynamics of the two patient groups were then assessed via a longitudinal comparative analysis. RESULTS: At 3 and 7 days, the ES group demonstrated markedly higher postoperative PHE volumes and greater postoperative mass effect volumes than the SA group. However, the ES group exhibited significantly lower postoperative hematoma volumes and lower postoperative mass effect volumes at 6 hours and 1 day (p < 0.001). The multivariate analysis revealed that postoperative mass effect volume at 7 days was a significant predictor of poor prognosis. CONCLUSION: Endoscopic surgery may lead to lower PHE and mass effect volumes at 6 hours after surgery, but higher PHE volumes after 3 days. In contrast, stereotactic aspiration is associated with lower PHE and mass effect volumes over 7 days. Additionally, the postoperative mass effect volume at 7 days was identified as a significant independent risk factor for poor long-term functional outcomes.