Document Type

Article

Publication Date

8-5-2026

Comments

This article is the author's final published version in Neurosurgical Review, Volume 49, Issue 1, 2026, Article number 512.

The published version is available at https://doi.org/10.1007/s10143-026-04426-3. Copyright © The Author(s) 2026.

Abstract

Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral hemorrhage (sICH) includes endoscopic evacuation and catheter-based evacuation (aspiration or drainage ± thrombolysis), but comparative performance remains uncertain. We performed a systematic review and meta-analysis comparing MIS approaches. PubMed, Embase, and CENTRAL were searched (December 2025) for studies in adults undergoing endoscopic or catheter-based MIS for supratentorial sICH. Random-effects meta-analysis was conducted. Prespecified subgroup analyses stratified catheter-based techniques by thrombolysis use. Risk of bias and certainty of evidence was assessed. Twenty-nine studies (8221 patients; 5041 endoscopic; 3180 catheter-based) were included. Endoscopic evacuation was associated with lower mortality (RR 0.64; 95% CI: 0.47–0.87; P <  0.01; I2 = 44.8%), rebleeding (RR 0.58; 95% CI: 0.39–0.87; P <  0.01; I2 = 22.2%), postoperative hematoma volume (MD -5.6 mL; 95% CI: -10.30–0.90; P <  0.05; I2 = 96.9%), and higher day-one evacuation rate (MD 24.5%; 95% CI: 14.60–34.40; P <  0.001; I2 = 99.7%). Overall complications (RR 0.98; 95% CI: 0.78–1.25; P = 0.90; I2 = 48.5%) and infection (RR 1.03; 95% CI: 0.64–1.66; P = 0.05; I2 = 43.6%) were similar. Catheter-based approaches had lower intraoperative blood loss (MD 69.0 mL; 95% CI: 27.7–110.4; P <  0.001; I2 = 96.9%). Subgroup analyses suggested that mortality and evacuation rate differences favored catheter-based cohorts receiving thrombolysis. Functional outcomes diverged: GCS/GOS favored endoscopy (SMD 0.27) while mRS marginally favored catheter-based approaches (MD 0.28), a between-group difference below the threshold generally considered clinically meaningful. Endoscopic evacuation was associated with lower mortality, rebleeding, and residual hematoma burden, while catheter-based approaches retained perioperative efficiency advantages. Functional findings were mixed and of uncertain clinical significance. Given predominantly non-randomized evidence and heterogeneity, these findings should be interpreted as strategy-specific associations.

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Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

42552275

Language

English

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