Neuroendoscopic surgery versus external ventricular drainage for spontaneous intraventricular hemorrhage: a systematic review and meta-analysis.

OBJECTIVE

To compare the efficacy and safety of neuroendoscopic surgery (NES) versus external ventricular drainage (EVD) in treating spontaneous intraventricular hemorrhage (IVH).

METHODS

A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for studies published up to March 1, 2025. Randomized controlled trials and observational studies comparing NES with EVD for spontaneous IVH were included. Primary outcomes were good functional outcome (GOS 4-5 or mRS 0-2) and mortality. Secondary outcomes included length of hospital/ICU stay and ventriculoperitoneal shunt (VPS) rate. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using random- or fixed-effects models.

RESULTS

Sixteen studies involving 992 patients (487 NES, 505 EVD) were included. NES was associated with significantly higher rates of good functional outcome (OR 2.46, 95% CI 1.79-3.39; I2=28%), lower mortality (OR 0.46, 95% CI 0.28-0.77; I2=25%), reduced VPS dependence (OR 0.20, 95% CI 0.13-0.30; I2=0%), and shorter hospital/ICU stays (WMD -4.82 days, 95% CI -7.98 to -1.66; I2=97%) compared to EVD.

CONCLUSION

Neuroendoscopic surgery demonstrates superior clinical outcomes over EVD for spontaneous IVH, including better functional recovery, lower mortality, reduced shunt dependency, and shorter hospitalization. However, given the limited number of randomized trials and regional heterogeneity, further high-quality multicenter RCTs are warranted to confirm these findings.