[Neuroendoscopic Evacuation of Intracerebral Hematomas : Approaches and Clinical Strategies by Lesion Location].

Intracerebral hemorrhage (ICH), a hemorrhagic stroke subtype, is associated with high mortality and severe disability. Conventional craniotomy has long been the standard surgical approach; however, its invasiveness often results in postoperative complications and prolonged recovery time. Neuroendoscopic hematoma evacuation has emerged as a minimally invasive alternative that offers reduced blood loss, shorter operative time, and improved neurological outcomes if appropriately applied. Recent meta-analyses and international guidelines supports its role in lowering mortality, shortening hospital stay, and decreasing infection rates compared to craniotomy. Careful preoperative evaluation, including patient background, anticoagulant or antiplatelet status, and vascular imaging, is essential to determine suitability and exclude vascular malformations or tumor-related hemorrhages. Surgical strategies must balance endoscopic and open approaches according to the hematoma location, volume, consistency, and associated pathology. Superficial, large, or firm hematomas often require small craniotomies and two-hand techniques, whereas deeper or ventricular lesions require burr hole surgery. Additionally, instrument selection and operative maneuvers are critical for safe and effective evacuation. Neuroendoscopic hematoma removal, if performed properly, represents a promising standard of care for ICH, combining minimal invasiveness with favorable clinical outcomes.