TOPLINE:

Minimally invasive surgery (MIS) for spontaneous intracerebral hemorrhage (ICH) was associated with lower in-hospital mortality and better discharge outcomes than conventional open craniotomy, a new study showed. 

METHODOLOGY:

• Researchers conducted a retrospective cohort study using the American Heart Association Get With The Guidelines-Stroke registry.
• The analysis included nearly 8000 patients (mean age, 59.7 years; 56% men) with spontaneous ICH who underwent surgical clot evacuation between 2011 and 2021.
• Two surgical approached were compared: MIS (n = 703), a composite that included stereotactic evacuation of the hematoma with instillation of a fibrinolytic agent and endoscopic hematoma evacuation, and open craniotomy with clot evacuation (n = 7067).
• The primary outcome was in-hospital mortality; secondary outcomes included unfavorable discharge (defined as a composite of in-hospital mortality or hospice discharge), discharge to inpatient rehabilitation, ambulatory status at discharge, and discharge modified Rankin Scale (mRS) scores.

TAKEAWAY:

• MIS was associated with a greater reduction in in-hospital mortality than open craniotomy (adjusted odds ratio [aOR], 0.7; P < .05).
• MIS was also associated with lower odds of unfavorable discharge (aOR, 0.75; adjusted risk difference [ARD], -0.05) and higher odds of discharge to rehabilitation (aOR, 1.25; ARD, 0.06), but there was no significant association with functional outcomes at discharge, including ambulatory status or mRS scores.
• In adjusted analyses, stereotactic MIS was linked to significantly lower odds of mortality than open craniotomy (aOR, 0.5; ARD, -0.07), whereas endoscopic MIS was not.
• Subgroup analyses showed particularly beneficial outcomes with MIS vs open craniotomy in older adults (age, 65 years or older) compared to their younger peers and in men vs women (P = .04 for both).

IN PRACTICE:

“Studies with long-term follow-up functional outcome measures are [now] needed to fully understand the impact of MIS on ICH treatment,” the investigators wrote.

SOURCE:

The study was led by Santosh B. Murthy, MD, Weill Cornell Medicine, New York City. It was published online on December 30, 2025, in Annals of Neurology.

LIMITATIONS:

The registry lacked detailed imaging data on spontaneous ICH characteristics, including ICH location and hematoma volume, which likely introduced unmeasured bias. The timing of surgery, which could have affected outcomes, was not recorded for most patients. Additionally, the analysis combined different MIS techniques, which could have obscured specific advantages of individual approaches.

DISCLOSURES:

One investigator reported receiving personal fees from Medtronic, and another received grant support from Stryker, MicroVention, Inc., and Penumbra. The remaining 15 investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.