Comparative Efficacy and Outcomes of Neuroendoscopy Versus Conventional Craniotomy for Intracerebral Hemorrhage: A Systematic Review AND Retrospective Cohort Study

Objective Intracerebral hemorrhage (ICH) is a common neurosurgical emergency associated with high mortality and disability rates. This study aimed to compare the efficacy and clinical outcomes of neuroendoscopic hematoma evacuation versus traditional craniotomy in treating ICH. Methods A systematic review search was conducted across PubMed, Embase, and Web of Science databases. Primary outcomes assessed were good functional outcome (GFO) and hematoma clearance rate. Additionally, we performed a retrospective analysis of 80 consecutive ICH patients treated at the First Affiliated Hospital of Soochow University between October 2022 and October 2024. All patients underwent standardized neurosurgical assessment upon admission. Baseline characteristics, perioperative variables, surgical outcomes, and prognostic indicators were systematically compared between the neuroendoscopy and craniotomy cohorts. Results Following PRISMA guidelines, we included 3 randomized controlled trials (RCTs) and 2 retrospective cohort studies in our meta-analysis and our institutional data. The primary outcome analysis demonstrated that the neuroendoscopy group achieved significantly higher hematoma clearance rates (SMD = 10.7, 95% CI 5.39–16.01, P  < 0.0001) and better functional outcomes (RR = 1.43, 95% CI 1.05–1.96, P  = 0.03) compared to the craniotomy group. In our retrospective analysis, the neuroendoscopy group showed superior outcomes in operative time ( P  < 0.001), bone window size ( P  < 0.001), intraoperative blood loss ( P  < 0.001), and hematoma clearance ( P  < 0.001), along with fewer postoperative complications ( P  < 0.05) and shorter hospital stays (8.85 ± 1.81 days vs. 11.73 ± 2.92 days, P  < 0.001). No significant difference was observed in postoperative rebleeding rates between groups ( P  = 0.440). Although both groups showed improvement in Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores, the neuroendoscopy group demonstrated better prognostic outcomes ( P  < 0.05). Conclusion Neuroendoscopic hematoma evacuation represents a rapid, safe, and effective minimally invasive approach for ICH management. Compared with conventional craniotomy, this technique demonstrates superior outcomes, including improved surgical efficiency, reduced complication rates, and enhanced patient prognosis.