Endoscopic Surgery for Lobar Hemorrhage in Older Adults: A Consistency-Guided Timing Approach

Endoscopic Surgery for Lobar Hemorrhage in Older Adults: A Consistency-Guided Timing Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endoscopic Surgery for Lobar Hemorrhage in Older Adults: A Consistency-Guided Timing Approach Norichika Hashimoto¹, Makoto Isozaki², Hatsuji Uno¹, Tetsuro Tsuji¹, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8387066/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Surgical decision-making in older adults with spontaneous intracerebral hemorrhage (ICH) is complicated by hematoma consistency, frailty, and anesthesia risks. Endoscopic evacuation under local anesthesia is minimally invasive, but optimal timing and functional assessment remain uncertain. Objective To evaluate the safety and efficacy of consistency-guided endoscopic hematoma evacuation in the subacute phase and determine prognostic factors influencing recovery using the modified Rankin Scale (mRS) and Functional Independence Measure (FIM). Methods We retrospectively analyzed 52 patients aged ≥ 70 years with spontaneous ICH treated between April 2013 and April 2024 and classified hematomas as solid (day 0), firm (days 1–6), soft (days 7–9), and liquefied (day ≥ 10). Endoscopic evacuation was performed in the soft or liquefied phases using a rigid neuroendoscope and transparent sheath with hemostasis achieved using topical Avitene® and saline irrigation. Ninety-day outcomes were assessed using the mRS and FIM, and multivariable regression identified predictors of poor recovery. Results Endoscopic evacuation achieved effective hematoma removal, significantly shorter operative times, and no respiratory complications. Advanced age and lower admission Glasgow Coma Scale score independently predicted poor outcomes. Patients with hematomas ≥ 50 mL showed significantly better outcomes with endoscopic evacuation. The FIM also detected functional gains at ≥ 40 mL that were not captured by the mRS, underscoring its complementary role. Conclusion Consistency-guided subacute endoscopic evacuation under local anesthesia is safe and effective for older adults with ICH, particularly those with large hematomas. Incorporating the FIM with the mRS improves sensitivity for detecting functional recovery and supports broader treatment eligibility. Endoscopic hematoma evacuation Spontaneous intracerebral hemorrhage subacute phase surgery Minimally invasive neurosurgery Figures Figure 1 Figure 2 Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8387066","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":569115987,"identity":"07ea3076-d1d9-4364-99d7-40cd2b66f0d0","order_by":0,"name":"Norichika 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1","display":"","copyAsset":false,"role":"figure","size":147940,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTimeline of hematoma evolution and surgical strategies.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn day 0, the hematoma was solid with an increasing mass effect. During the acute phase, the clot remains firm, and the mass effect continues to rise, often necessitating urgent craniotomy in cases of neurological deterioration. In the early phase, the hematoma softens, and the mass effect peaks. In the subacute phase, the hematoma liquefies, and the mass effect gradually declines, allowing for endoscopic evacuation under local anesthesia.\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8387066/v1/de8aa2a30f30530809b1e9c5.jpg"},{"id":99793130,"identity":"3e90e532-20b3-4de5-ae24-13b5f75dac28","added_by":"auto","created_at":"2026-01-08 13:31:03","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":489130,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStepwise endoscopic technique for hematoma evacuation and topical hemostasis using powdered Avitene®.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePanel A shows the hematoma aspiration performed piece by piece using the suction tube tip. Panel B demonstrates the topical application of powdered Avitene® into the oozing hematoma cavity following bipolar coagulation. Panel C illustrates irrigation with sterile saline or artificial CSF, producing a red sealing zone that confirms complete hemostasis.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8387066/v1/0a9fb5e2655d524d825c7b85.jpg"},{"id":102295745,"identity":"bfc42b20-172e-4a8b-b530-8da732ad76a8","added_by":"auto","created_at":"2026-02-10 10:14:34","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1151861,"visible":true,"origin":"","legend":"","description":"","filename":"MainTxetRev20251217Hashimoto.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8387066/v1_covered_46e72381-9e44-4af8-98e1-52ce081f48a8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Endoscopic Surgery for Lobar Hemorrhage in Older Adults: A Consistency-Guided Timing Approach","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endoscopic hematoma evacuation, Spontaneous intracerebral hemorrhage, subacute phase surgery, Minimally invasive neurosurgery","lastPublishedDoi":"10.21203/rs.3.rs-8387066/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8387066/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSurgical decision-making in older adults with spontaneous intracerebral hemorrhage (ICH) is complicated by hematoma consistency, frailty, and anesthesia risks. Endoscopic evacuation under local anesthesia is minimally invasive, but optimal timing and functional assessment remain uncertain.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the safety and efficacy of consistency-guided endoscopic hematoma evacuation in the subacute phase and determine prognostic factors influencing recovery using the modified Rankin Scale (mRS) and Functional Independence Measure (FIM).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed 52 patients aged\u0026thinsp;\u0026ge;\u0026thinsp;70 years with spontaneous ICH treated between April 2013 and April 2024 and classified hematomas as solid (day 0), firm (days 1\u0026ndash;6), soft (days 7\u0026ndash;9), and liquefied (day\u0026thinsp;\u0026ge;\u0026thinsp;10). Endoscopic evacuation was performed in the soft or liquefied phases using a rigid neuroendoscope and transparent sheath with hemostasis achieved using topical Avitene\u0026reg; and saline irrigation. Ninety-day outcomes were assessed using the mRS and FIM, and multivariable regression identified predictors of poor recovery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEndoscopic evacuation achieved effective hematoma removal, significantly shorter operative times, and no respiratory complications. Advanced age and lower admission Glasgow Coma Scale score independently predicted poor outcomes. Patients with hematomas\u0026thinsp;\u0026ge;\u0026thinsp;50 mL showed significantly better outcomes with endoscopic evacuation. The FIM also detected functional gains at \u0026ge;\u0026thinsp;40 mL that were not captured by the mRS, underscoring its complementary role.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eConsistency-guided subacute endoscopic evacuation under local anesthesia is safe and effective for older adults with ICH, particularly those with large hematomas. Incorporating the FIM with the mRS improves sensitivity for detecting functional recovery and supports broader treatment eligibility.\u003c/p\u003e","manuscriptTitle":"Endoscopic Surgery for Lobar Hemorrhage in Older Adults: A Consistency-Guided Timing Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-06 10:55:23","doi":"10.21203/rs.3.rs-8387066/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7f8d8c76-f61b-43cb-9f0f-c5ddee76a407","owner":[],"postedDate":"January 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-06T21:24:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-06 10:55:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8387066","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8387066","identity":"rs-8387066","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}