Neuroendoscopy in Acute and Severe Neurological Diseases: A Promising Approach for Improved Patient Outcomes

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Methods: Between September 2016 to December 2023, a total of 815 patients with acute and severe neurological disease treated by transcranial neuroendoscopic approach were retrospectively reviewed in our department. Results: Among the 815 acute and severe cases, 474 cases of acute cerebral hemorrhage, 248 cases of hemorrhagic cerebrovascular diseases, 78 cases of craniocerebral injury and 15 cases of acute hydrocephalus. The outcomes of our neuroendoscopic surgery were satisfactory without any severe complications and the procedure was life-saving and showed promising outcomes in terms of patient safety and recovery. Conclusion: While neuroendoscopy represents a promising approach in the treatment of some acute and severe neurological disease, ongoing research and technological advancements are necessary to optimize its utility and ensure its widespread adoption. This article aims to provide a comprehensive overview of the current state of neuroendoscopy in acute and severe neurological diseases, underscoring its potential to improve patient outcomes and quality of care in neurosurgical practice. Health sciences/Neurology/Neurological disorders Health sciences/Neurology/Neurological disorders/Brain injuries Acute and Severe neurological disease Neuroendoscopic approach Minimally invasive neuroendoscopic 3D-Slicer+MosoCam/Sina Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Introduction Neuroendoscopy involves utilizing minimally invasive neuroendoscopic(MIN) techniques in neurosurgery for both diagnosing and treating various neurological diseases [ 1 , 2 ] . This MIN surgical technique offers a unique approach to accessing and treating intracranial pathologies with precision and minimal trauma to surrounding tissues [ 3 ] . Neuroendoscopy has shown positive outcomes in intracranial hemorrhages, such as intraventricular hemorrhage (IVH) and subdural hematoma (SDH) [ 4 , 5 ] . Traditional methods involved using open craniotomy procedures to remove blood clots; however, advancements in neuroendoscopic techniques now enable less invasive way to clear hematomas. This reduces the chances of complications and enhances patient recovery time [ 9 , 10 ] . Neuroendoscopy has recently gained significant attention and now widely used in the treatment of neurological. This innovative method has revolutionized neurosurgery by offering less invasive techniques that lead to improved patient outcomes [ 11 , 12 ] . However, the utilization of a neuroendoscope in patients with severe neurological diseases remains limited, with only a few reported cases [ 6 – 8 ] . Many neurosurgeons remain hesitant to incorporate a neuroendoscope in the management of acute and severe neurological conditions. Currently, the application scope of neuroendoscopy primarily includes three aspects: ventricular endoscopy, initially less common but now an integral part of the technique; transsphenoidal endoscopy, currently the primary application field; and the emerging trend of transcranial endoscopy, which holds promise for the future. From September 2016 to December 2023, we have successfully applied neuroendoscopic technique in 815 cases of acute and severe cases. Among which 474 cases of cerebral hemorrhage (180 cases of Basal ganglia cerebral hemorrhage; 100 cases of Thalamic hemorrhage; 80 Cerebral lobe hemorrhage; 58 Brain stem hemorrhage; 40 cases of Ventricular hemorrhage; 26 cases of Cerebellar hemorrhage), Hemorrhagic cerebrovascular diseases (210 cases of aneurysm, 24 cases of vascular malformation, 4 cases of arteriovenous fistula, 10 cases of moyamoya disease complicated with hemorrhage), craniocerebral injury(32 cases of epidural hematoma and 46 cases of contusion and laceration with intracerebral hematoma) and 15 cases of acute hydrocephalus. This article aims to explore the growing role of neuroendoscopy in the management of various acute and severe neurological diseases, highlighting its efficacy, safety, and future prospects. Methods This study included a total of 815 patients by a neuroendoscopic approach in our department between September 2016 to December 2023. The aim of this study was to retrospectively investigate the data of patients with Acute and Severe neurological disease. There were 556 males and 269 females, and the age ranged from 28 to 83 years (mean 54.6 years). Preoperative computed tomography (CT) scans were carried out in all the patients to rule out neoplasia or other intracranial disease, The study protocol was approved by the Ethics Committee of our hospital (WDRY2022-K099), and Informed consent was obtained from all patients or their legal guardians for the publication of any identifying information or images in an online open-access publication. Patient confidentiality and privacy were maintained throughout the process in accordance with ethical guidelines and institutional policies. The inclusion criteria were as follows: ① patients with Intracerebral Hemorrhage; ② patients with Hemorrhagic cerebrovascular diseases; ③ patients with Intracranial aneurysm; ④ patients with craniocerebral injury; and ⑤ patients with acute hydrocephalus;. The exclusion criteria were as follows: ① conservative treatment without surgery; ② chronic patients; ③ conservative drug treatment; and; ④ incomplete follow-up data. We studied 815 cases of Acute and Severe neurological disease who underwent neuroendoscopic approach in our department within the period between September 2016 to December 2023 at our hospital. Patients were divided into four categories: there were 474 cases of cerebral hemorrhage, 248 cases of Hemorrhagic cerebrovascular diseases, 78 cases of craniocerebral injury and 15 cases of acute hydrocephalus (Table 1 ). Table 1 Demographics and Characteristics of Patients Category Number of Cases Subtypes Included Cerebral Hemorrhage 474 Basal Ganglia: 180, Thalamic: 100, Cerebral Lobe: 120, Brain Stem: 48 ,Ventricular: 40, Cerebellar: 26 Hemorrhagic Cerebrovascular Diseases 248 Aneurysm: 210, Vascular Malformation: 24, Arteriovenous Fistula: 4, Moyamoya Disease with Hemorrhage: 10 Acute and subacute Craniocerebral Injury 78 Epidural Hematoma: 32, Contusion and Laceration with Intracerebral Hematoma: 46, Acute Hydrocephalus 15 Total 815 Table 1 summarizes the distribution of patients across different categories based on their presenting conditions. Cerebral hemorrhage was the most common condition, followed by hemorrhagic cerebrovascular diseases, craniocerebral injury, and acute hydrocephalus. Operative technique The minimally invasive neuroendoscopic (MIN) technique was employed under general anesthesia for patients with acute and severe neurological diseases. The positioning and incision approach varied based on each neurological condition. To ensure optimal access and minimize potential complications, the patient was positioned accordingly, such as in a supine position with a slightly elevated head to aid venous drainage and reduce brain swelling. The scalp incision was made over the planned entry point, and careful measures were taken to preserve surrounding structures while creating a burr hole or minicraniotomy using a high-speed drill. The dura is carefully opened in a cruciate manner using either scissors or a scalpel. The resulting dural flaps are gently retracted, allowing for exposure of the surgical site. In order to visualize the area, a rigid endoscope with a 0° or 30° angle (such as the Karl Storz endoscope from Germany) is inserted into the space created by the hematoma. Continuous irrigation is applied to ensure a clear surgical field, while suction is utilized as needed to remove any blood and debris from the area. Under direct endoscopic visualization, the cerebral contusion or laceration and hematoma are meticulously removed, gentle manipulation and suctioning are performed to evacuate the hematoma while minimizing damage to surrounding healthy tissue. Any visible bleeding was managed using a bipolar coagulator with low output power. Hemostasis is achieved meticulously to prevent re-bleeding and minimize postoperative complications. Following hematoma evacuation, a soft catheter is carefully inserted into the hematoma cavity to drain any remaining liquid hematoma and the catheter is secured and connected to a closed drainage system to monitor and control postoperative drainage. The dura is closed using a standard technique, ensuring watertight closure. The bone flap is repositioned and fixated using miniplates and screws. The scalp incision is closed in layers, ensuring hemostasis and proper wound approximation. Results Demographics and other characteristics In our study there are of 815 patients, among which 556 males and 269 females(ranged from 28 to 83 years). All patients underwent surgery within 72 hours. we divided patient into four categories based on their conditions: 474 cases of cerebral hemorrhage, 248 cases of hemorrhagic cerebrovascular diseases, 78 cases of craniocerebral injury, and 15 cases of acute hydrocephalus (Table 1 ). The neurological status of the patients was evaluated using the Glasgow Coma Scale (GCS) scores. For each neurological condition, the complete hematoma clearance rates rate was more than 90%. Furthermore, we saw higher GCS scores at discharge, which suggests better neurological function and possible recovery. Clinical presentation 1. Cerebral hemorrhage 1.1 Cerebral hemorrhage in basal ganglia A 50-year-old man was brought to our department after undergoing emergency drilling and drainage locally for cerebral hemorrhage management. Upon arrival, he was conscious with equal-sized and round pupils, but unresponsive to light. He also had complete left limb weakness. A CT scan revealed cerebral hemorrhage in the right basal ganglia, insula, temporal lobe, along with subarachnoid hemorrhage post-drainage. Given the potential advantages of neuroendoscopy, we opted for this approach to maximize hematoma removal. The procedure provided excellent maneuverability, achieving a 94% clearance rate. Overall, the surgery yielded satisfactory results, with the patient showing significant improvement(Fig. 1 ). This case underscores the effectiveness of neuroendoscopy in intricate cerebral hemorrhage cases, offering high clearance rates and favorable clinical outcomes. 1.2 Thalamic Hemorrhage A 69-year-old man was admitted to our hospital after being discovered unconscious for two hours while showering. A head CT scan showed a left thalamic hemorrhage and bleeding into the right lateral ventricle. The patient presented with a low level of consciousness and unequal pupil sizes, with the left pupil being larger than the right. The pupillary light reflex was slow. The hemorrhage in the thalamus and brainstem caused hydrocephalus, which was life-threatening. A successful minimally invasive neuroendoscopic surgery called "sheath within sheath" was performed, removing 97% of the hematoma(Fig. 2 ). The procedure's results are promising, giving him hope for a full recovery. 1.3 Cerebral Lobe Hemorrhage A 60-year-old woman experienced dizziness and discomfort in the morning, which persisted despite rest. A head CT scan revealed a hemorrhage in the left parietal lobe. The patient also suffered from recurrent vomiting. Since the onset of symptoms, the patient has been in a shallow coma and unable to orally consume fluids. She has a urinary catheter in place and functioning properly. Her Glasgow Coma Scale (GCS) score is 7, and both pupils are equal in size, approximately 2 mm in diameter, with no response to light. The preoperative hematoma volume was measured at 40.3 ml, which significantly decreased to 0.6 ml after surgery. Impressively, the hematoma clearance rate reached 98.5% using 3D-slice software. The patient's recovery has been excellent(Fig. 3 ). 1.4 Brainstem Hemorrhage 52-year-old female patient was admitted to our department in a comatose state. Her examination revealed bilateral enlarged pupils, partially open eyes with tingling pain, and an absence of response to stimuli. In moreover, the patient experienced limb tingling and buckling, as well as neck stiffness. A CT scan showed the presence of a pontine and subarachnoid hemorrhage.. we employed a "2-in-1" surgical technique. This procedure involved two key steps. The first step involved puncture drainage, which facilitated rapid hypotension. This approach aimed to swiftly and completely reduce intracranial pressure(ICP), which is especially crucial in cases of brain stem hematomas. The second step was endoscopic removal of the hematoma, utilizing the advantages of minimally invasive surgery. After the surgical intervention, postoperative CT revealed a hematoma clearance rate of 83.5%. Although not achieving complete clearance, the outcome was still considered satisfactory(Fig. 4 ), considering the challenging nature of the brain stem hemorrhage. This case highlights the application of a combined surgical technique and concept to effectively manage pontine hemorrhages. The use of rapid hypotension and neuroendoscopy played crucial roles in the treatment, allowing for significant reduction in hematoma size and improvement in the patient's condition. 1.5 Intraventricular hemorrhage A 55 years old Female was admitted to our hospital with clear consciousness but in poor spirits. CT scan revealed intraventricular hematoma. The patient underwent minimally invasive neuroendoscopic surgery, which was performed with a unilateral approach to remove bilateral lateral ventricle and third ventricle hematomas simultaneously. This technique allowed us to achieve precise visualization and targeted removal of the hematomas within the ventricular system. Postoperatively, there was a remarkable improvement in the patient's condition. The patient regained consciousness the very next day after the procedure, indicating a positive outcome. The result of the surgery was satisfactory(Fig. 5 ). 1.6 Cerebellar Hemorrhage A 72-year-old woman was brought to our department in a comatose state (GCS 6, E1V2M3), with equal and reactive pupils measuring 2 mm. She was presented with an unexpected loss of consciousness. A CT scan revealed a large right cerebellar hemorrhage that extended into the ventricle. The preoperative hematoma volume was significant, at around 41.9 ml, with the hematoma spreading across the midline and putting pressure on the brainstem, posing a life-threatening situation. The patient had neuroendoscopic minimally invasive surgery, which resulted in a 91.2% hematoma clearance rate. The results are encouraging, raising hopes for her recovery(Fig. 6 ). 2 . Hemorrhagic Cerebrovascular Diseases 2.1(a) Clipping of Anterior communicating artery aneurysm by eyebrow arch keyhole approach A 42 years old male was admitted to our hospital due to a headache lasting for 4 hours. On admission, a CT scan revealed subarachnoid hemorrhage, and a preoperative CT angiography (CTA) showed an anterior communicating artery aneurysm. The patient underwent neuroendoscopic minimally invasive clipping of the anterior communicating artery aneurysm using the supraorbital keyhole approach. The aneurysm was successfully clipped during the procedure. On the three-month follow-up examination after the surgery, the patient showed a good recovery(Fig. 7 ). 2.1(b) The neuroendoscopic "three-in-one" procedure was successfully performed on aneurysms and giant hematoma A 49-year-old female patient was admitted to our hospital in a deeply comatose state with dilated pupils on one side. Prior to surgery, both pupils exhibited dilation. Diagnostic imaging revealed a massive hematoma in the left basal ganglia region on CT scan, while CTA demonstrated an aneurysm located in the middle cerebral artery and A1 segment. To address these critical conditions, a "Three-in-One" surgical technique and concept were employed, aiming to remove the hematoma and clip the aneurysm: Step one involved rapid decompression through puncture and drainage, resulting in a prompt reduction of blood pressure. This initial step was crucial in stabilizing the patient's condition. In step two, the hematoma was meticulously removed using an endoscopic approach, and the aneurysm was successfully clipped, preventing further complications. Step three consisted of the removal of the bone flap, further optimizing the surgical outcome. Following the procedure, the patient exhibited a remarkable recovery. Consciousness was regained, and the left limbs demonstrated normal functionality. The muscle strength in the right limbs improved to grade 3, indicating significant progress. Ultimately, the patient was discharged successfully, having achieved a favorable outcome(Fig. 8 ). 2.2 Vascular Malformation A 28-year-old male presented with spontaneous intraventricular hemorrhage and was admitted to the hospital. CTA revealed a giant vascular malformation. Preoperatively, the patient developed hydrocephalus and underwent emergency external ventricular drainage followed by interventional treatment. Partial embolization of the vascular malformation was performed under the premise of safety. Ten days postoperatively, the patient experienced bleeding, which was managed by endoscopic evacuation of the hematoma and occlusion of the partially supplying arteries. The patient had a smooth recovery and was discharged. Follow-up examination two months later showed favorable outcomes(Fig. 9 ). 2.3 Arteriovenous Fistula A 60-year-old male patient suddenly experienced pain and vomiting for no apparent reason about 8 hours ago. CT scan revealed a hemorrhage in the left temporal lobe. Preoperative CTA revealing vascular malformation and arteriovenous fistula. The patient underwent a minimally invasive neuroendoscopic surgery to remove the hematoma and correct the vascular malformation. The surgery achieved an impressive hematoma clearance rate of 98.4%. After the procedure, the patient recovered well(Fig. 10 ). 2.4 Moyamoya Disease with Hemorrhage A 48-year-old woman with a history of hypertension was admitted to the hospital after developing sudden aphasia, left upper limb weakness, vomiting, and coma. A head CT scan revealed a hemorrhage in the right temporal-parietal lobe that spread into the ventricle. The patient also had stage 3 hypertension and signs of impending brain herniation. To treat the intraventricular hemorrhage, the patient had neuroendoscopic surgery. Postoperative CTA results indicated the presence of Moyamoya disease. However, the patient demonstrated improved consciousness and a successful surgical outcome(Fig. 11 ). 3. Craniocerebral Injury 3.1 Neuroendoscopic minimally invasive surgery for acute cerebral contusion and laceration subdural with intracerebral hematoma A 33-year-old female with drowsiness and altered consciousness was admitted to our hospital 7 hours after a traumatic car accident. CT scan revealed a left temporal lobe contusion injury, subdural hematoma at the frontal-temporal vertex of the left side, and subarachnoid hemorrhage. the patient underwent neuroendoscopic evacuation of the intracerebral hematoma. This surgical intervention utilized a neuroendoscope to meticulously remove the hematoma from within the brain. The patient regained consciousness the second day after surgery(Fig. 12 ), and the overall outcome was favorable. 3.2 Neuroendoscopic modified surgical approach for acute epidural hematoma and brain contusion A 49 years old male suffered from "Head and facial trauma with temporary disturbance of consciousness for 7 hours" admitted in our ward. He was delirious and had a right frontal small epidural hematoma. After 6 hours of conservative treatment, the patient's level of consciousness deteriorated further, and a CT scan revealed the enlargement of the hematoma.. An emergency hematoma removal surgery was performed under neuroendoscopic approach, which allowed for precise visualization and removal of the hematoma. The patient regained consciousness and recovered after surgery(Fig. 13 ). The successful outcome demonstrates the benefits of utilizing neuroendoscopy for emergent cases of hematoma removal, improving patient prognosis and overall recovery. 4. Acute Hydrocephalus 4.1 Surgical treatment of midbrain aqueduct hematoma with Acute obstructive hydrocephalus A 78-year-old female patient was admitted to our department in critical condition after presenting with coma. A preoperative CT scan showed hydrocephalus and a high-density shadow in the third ventricle. The patient underwent an emergency neuroendoscopic procedure overnight, which included creating a ventriculostomy at the ventricular floor, investigating abnormalities in the shunt system, and removing the hematoma. The patient regained consciousness the second day following surgery, and the overall outcome was positive(Fig. 14 ). Discussion Neuroendoscopy has emerged as an effective minimally invasive technique for treating acute and severe neurological diseases. This approach has several advantages over traditional open surgery, including less trauma to surrounding tissues, faster recovery times, and lower complication rates [ 13 ] . Neuroendoscopy has demonstrated promise in improving patient outcomes in acute conditions such as traumatic brain injury, intracerebral hemorrhage, and severe hydrocephalus [ 10 , 11 , 14 , 15 ] . One of the primary advantages of neuroendoscopy is its ability to provide direct visualization and access to deep-seated lesions or areas that are difficult to reach using traditional surgical methods [ 16 ] . This precise targeting can result in more effective lesion removal, better decompression of brain structures, and improved cerebrospinal fluid flow [ 17 ] . In patients undergoing neuroendoscopic procedures for conditions such as intraventricular hemorrhage evacuation and tumor resection, studies have reported favorable outcomes in terms of reduced morbidity and mortality rates [ 18 , 19 ] . Furthermore, neuroendoscopy allows surgeons to assess tissue and fluid dynamics in real time, allowing them to make informed decisions and adjust their approach throughout the procedure [ 20 ] . The dynamic nature of neuroendoscopic surgery can be especially useful in acute settings where prompt intervention is critical for patient survival and recovery. Despite the numerous benefits of neuroendoscopy, there are some challenges and limitations that must be addressed. These include the learning curve required to master neuroendoscopic techniques, the availability of specialized equipment and trained personnel, and the need for additional research to determine the long-term efficacy and safety of neuroendoscopic procedures in acute and severe neurological diseases. However, it may not be suitable for patients with skull fractures, multiple contusions, or those requiring decompressive craniectomy. Furthermore, the emergence of neuroendoscopy signifies not merely a passing trend, but rather the dawn of a new era in neurosurgery. Finally, neuroendoscopy looks very promising as a useful tool in the treatment of acute and severe neurological diseases. Future research should focus on optimizing surgical techniques, patient selection criteria, and long-term outcomes to further establish the role of neuroendoscopy in improving patient care. Conclusions The minimally invasive neuroendoscopic (MIN) approach for hematoma evacuation in acute and severe neurological diseases offers a safe and effective alternative to conventional open procedures. This technique allows for meticulous hematoma removal, precise hemostasis, and optimal visualization, with the added benefits of reduced surgical trauma and faster recovery. Proper patient selection and surgeon expertise are essential for achieving successful outcomes using this minimally invasive approach. Abbreviations MIN minimally-invasive neurosurgery IVH intraventricular hemorrhage CCI craniocerebral injury GCS Glasgow Coma Scale ICH intracerebral hematoma CT computed tomography CTA computed tomography angiography. Declarations Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to the need to protect patient privacy. Access to the data can be obtained from the corresponding author upon reasonable request. Author contribution Zohaib Shafiq, Zhiyang Li, Pan Lei were responsible for article design and draft writing; Ping Song, Long Zhou were responsible for data collection and processing, and Qiang Cai completed the review of the article. All authors gave final approval of the manuscript to be published. Funding This work was supported by the National Natural Science Foundation of China (82271518, 81971158, 81671306). Ethical approval This study was approved by the ethics committee of Renmin Hospital of Wuhan University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all patients or their legal guardians for the publication of any identifying information or images in an online open-access publication. Patient confidentiality and privacy were maintained throughout the process in accordance with ethical guidelines and institutional policies. Competing interests The authors declare no competing interests and none of the material in the paper has been published or is under consideration for publication elsewhere. References Li, K., Nelson, C., Suk, I., & Jallo, G. (2005). Neuroendoscopy: past, present, and future. Neurosurgical Focus, 19(6), E1. https://doi.org/10.3171/FOC.2005.19.6.2 Grunert, P., Gaab, M., Hellwig, D., & Oertel, J. (2009). German neuroendoscopy above the skull base. Neurosurgical Focus, 27(3), E7. https://doi.org/10.3171/2009.6.FOCUS09123 Shim, K., Park, E., Kim, D., & Choi, J. (2017). Neuroendoscopy: Current and Future Perspectives. 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Journal of Stroke and Cerebrovascular Diseases, 20(3), 208-213. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.11.021. Giannetti, A., Alvarenga, A., Lima, T., Pedrosa, H., & Souweidane, M. (2015). Neuroendoscopic biopsy of brain lesions: accuracy and complications. Journal of Neurosurgery, 122(1), 34-39. https://doi.org/10.3171/2014.9.JNS132648. Jiménez-Vázquez, O., & Nagore, N. (2008). The impact of neuroendoscopy in the emergency setting—A retrospective study of imaging, intraoperative findings, and surgical outcome in 55 patients. Clinical Neurology and Neurosurgery, 110, 539-543. https://doi.org/10.1016/j.clineuro.2008.02.019. 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. 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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-4356620","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":299688170,"identity":"1abb4c27-7698-488a-98cc-99984cd57704","order_by":0,"name":"ZOHAIB SHAFIQ","email":"","orcid":"","institution":"Renmin Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"ZOHAIB","middleName":"","lastName":"SHAFIQ","suffix":""},{"id":299688173,"identity":"76413478-3450-4f31-9e31-99860dfb3088","order_by":1,"name":"Zhiyang Li","email":"","orcid":"","institution":"Renmin Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Zhiyang","middleName":"","lastName":"Li","suffix":""},{"id":299688175,"identity":"6071bb55-b7dd-4e68-b7d7-42538614f3a1","order_by":2,"name":"Pan Lei","email":"","orcid":"","institution":"Renmin Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Pan","middleName":"","lastName":"Lei","suffix":""},{"id":299688177,"identity":"3b20bc57-b365-4755-931e-a4741548e7e3","order_by":3,"name":"Ping Song","email":"","orcid":"","institution":"Renmin Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Song","suffix":""},{"id":299688179,"identity":"7fa5a3e6-3463-42ab-bba1-fe46dfbc1268","order_by":4,"name":"Long Zhou","email":"","orcid":"","institution":"Renmin Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Long","middleName":"","lastName":"Zhou","suffix":""},{"id":299688180,"identity":"0977792a-6dad-493d-b47c-a0954c5338be","order_by":5,"name":"Qiang Cai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAlElEQVRIiWNgGAWjYLCCDwwSJOpgnEGyFmYekpTzt+cefGzzxyKPv4H54aMbxGiROPMu2Ti3TaJY4gCbsXEOMVoMJHLMpHMbJBIbDvCwSROvxeKPROJ80rQwsEkkbiBai8SZN8aGvW0SiRsPE+sX/vYcwwc//tQlzjve/PAxUVoYGBKgNDNxypG1jIJRMApGwSjABQC58CtZt2l6WgAAAABJRU5ErkJggg==","orcid":"","institution":"Renmin Hospital of Wuhan University","correspondingAuthor":true,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Cai","suffix":""}],"badges":[],"createdAt":"2024-05-02 03:40:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4356620/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4356620/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56884164,"identity":"500e19e0-8723-44d4-9783-53574624c258","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1288420,"visible":true,"origin":"","legend":"\u003cp\u003eRight Basal Ganglia Hemorrhage: A: Local hospital performed hematoma drainage through a burr hole. B:The preoperative hematoma was highly irregular. C: The incision line of endoscopic surgery was formed after extension over the original temporal incision. D: Hematoma was removed under endoscope. E\u0026amp;F: Postoperative CT scan showed satisfactory results. G: Preoperative hematoma volume was 60.3 ml. H: Postoperative hematoma was 3.7ml with a clearance rate of 93.9%.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/2b123af34942ee045e30506b.png"},{"id":56884416,"identity":"6f7730ba-8873-4b70-8d5e-be2c2cb8e5fd","added_by":"auto","created_at":"2024-05-21 17:56:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":857429,"visible":true,"origin":"","legend":"\u003cp\u003eNeuroendoscopic clearance of thalamic hemorrhage and breaking into the ventricles: A: CT on admission showed that the hematoma was located in the thalamus and affected the midbrain; B: CT on admission showed a small hematoma located in the thalamus, the patient's consciousness was clear, and conservative treatment was given; C: The hematoma expands and the patient's consciousness decreases after 4 hours of conservative treatment; D: Preoperative CT showed that the thalamic hematoma expanded and ruptured into the ventricles; E: A frontal straight minimally invasive skin incision was selected; F: The opening of thalamic hematoma ruptured into the ventricles was found after neuroendoscope introduced into lateral ventricle; G: Hematoma in thalamus and ventricles was removed under neuroendoscope; H: Postoperative CT showed ideal clearance of intraventricular hematoma; I: Postoperative CT showed ideal clearance of thalamic hematoma; J: Preoperative hematoma volume was 20.2ml calculated by 3D-Slicer software; K: Postoperative hematoma volume was 0.6ml and the hematoma clearance rate was 97.0%.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/86fc8814098c7a7c0e7eda1c.png"},{"id":56884417,"identity":"bf2bed5b-9bce-44ad-9f7d-ac8bd2f1728a","added_by":"auto","created_at":"2024-05-21 17:56:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":859311,"visible":true,"origin":"","legend":"\u003cp\u003eNeuroendoscopic minimally invasive surgery for parietal lobe hemorrhage breaking into the ventricles: A: Preoperative CT showed hematoma breaking into the ventricles; B: Preoperative CT showed hematoma located in the parietal lobe; C: A parietal straight minimally invasive skin incision was selected; D: Hematoma in parietal lobe was removed under neuroendoscope; E: Intraventricular hematoma was evacuated by neuroendoscope; F: Postoperative CT showed ideal clearance of intraventricular hematoma; G: Postoperative CT showed ideal clearance of parietal lobe hematoma; H: Preoperative hematoma volume was 40.3ml calculated by 3D-Slicer software; I: Postoperative hematoma volume was 0.6ml and the hematoma clearance rate 98.5%.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/b7292b38e6910560bbe2a36d.png"},{"id":56884166,"identity":"f51c43a5-00af-4e5e-97a0-4f8eaaf01ed4","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1391448,"visible":true,"origin":"","legend":"\u003cp\u003eA: Preoperative CT scan revealed brainstem hemorrhage: B: Subtemporal minimally invasive surgical incision was used. C: Entering the brainstem region, the trochlear nerve (black arrow) is clearly visible. D: The posterior cerebral artery was exposed. E: Enter the hematoma cavity. F: Place a micro-sheath to form a \"sheath in a sheath\". G: allowing direct visualization for hematoma evacuation. H: Monopolar coagulation was used to contact and cauterize small blood vessels within the brainstem for hemostasis. I: A firm \"clot-like\" substance was found on the ventral side of the brainstem. J: The suspected \"cavernous hemangioma\" -like material was removed. K: Complete hemostasis was achieved. L: Postoperative CT scan showed satisfactory results. M: Postoperative hematoma volume was 1.45 ml, with a clearance rate of 83.5%. N: Preoperative hematoma volume was 8.79 ml.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/1d7ead6b71ee50142afb4892.png"},{"id":56884502,"identity":"6a5410b4-1d41-4338-be5f-f3c3099c741b","added_by":"auto","created_at":"2024-05-21 18:04:19","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1792066,"visible":true,"origin":"","legend":"\u003cp\u003eIllustrates the Neuroendoscopic surgery for intraventricular hemorrhage complicated with moyamoya disease and hydrocephalus.\u003c/p\u003e\n\u003cp\u003eA: Preoperative CT scan shows intraventricular hemorrhage and hydrocephalus. B: Preoperative CT scan shows ventricular cast. C: Suggestive of Moyamoya disease. D: Minimally invasive surgical incision in the frontal region. E: Entry into the right ventricle to evacuate the intraventricular hematoma. F: Evacuation of the hematoma in the right lateral ventricle trigone area. G: Removal of intraventricular hematoma through the interventricular foramen. H: Opening of the septum pellucidum to access the left ventricle. I: Evacuation of the hematoma in the left lateral ventricle body area. J: Evacuation of the hematoma in the left lateral ventricle trigone area. K\u0026amp;L: Postoperative CT scan shows satisfactory results. M: Postoperative hematoma volume is 5.2 ml, with a clearance rate of 90%. N: Preoperative hematoma volume is 52.5 ml. O: Consciousness clear and in a good state on the second day after surgery.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/20eea5f481ce7da914734213.png"},{"id":56884167,"identity":"c93c2e51-e565-4b17-b7cb-7463aad71db9","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":761015,"visible":true,"origin":"","legend":"\u003cp\u003eNeuroendoscopic Minimally Invasive Surgery for Massive Cerebellar Hematoma. A\u0026amp;B: Massive cerebellar hematoma, scattered, crossing the midline, and extending into the ventricle. C: Minimally invasive surgical incision along the paramedian approach. D: Evacuation of the cerebellar hematoma. E: Opening of the fourth ventricle (floor) for clearance of intraventricular hematoma. F\u0026amp;G: Postoperative CT showing favorable results. H: Preoperative hematoma volume of 41.9 ml. I: Postoperative hematoma volume of 3.7 ml, with a clearance rate of 91.2%.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/140c0f1161a131523c73554a.png"},{"id":56884169,"identity":"27a252df-6cd7-4f7e-987e-2d6c6ea6e1e3","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":969876,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical Clipping of Anterior communicating artery aneurysm under neuroendoscope by eyebrow arch keyhole approach: A: CT showing subarachnoid hemorrhage(SAH). B: Preoperative CTA image revealing an anterior communicating aneurysm. C: Selection of eyebrow keyhole minimally invasive approach for surgical intervention.. D\u0026amp;E: Intraoperative image demonstrating endoscopic clipping of the aneurysm. F: Postoperative CT scan showing favorable surgical outcome. G: Postoperative CTA demonstrating complete clipping of aneurysm. H: Follow-up image showing good recovery three months after the surgery.\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/3667db5601d877fe3f567439.png"},{"id":56884891,"identity":"8c4f5afb-a297-49ea-8755-662ab7f87811","added_by":"auto","created_at":"2024-05-21 18:12:19","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":1875579,"visible":true,"origin":"","legend":"\u003cp\u003eThe neuroendoscopic \"three-in-one\" procedure in aneurysms and giant hematoma: A: Preoperative CT scan shows a hematoma located in the basal ganglia region, requiring differentiation from hypertensive intracerebral hemorrhage. B: Massive hematoma with significant midline shift. C: Preoperative CTA reveals a left middle cerebral artery aneurysm (Aneurysm 1). D: Simultaneously, an A1 segment aneurysm is found (Aneurysm 2). E: \"Three-in-one\" enlarged pterional approach incision line is chosen. F: Step 1: Partial hematoma evacuation for rapid decompression. G: Step 2: Endoscopic hematoma evacuation and clipping of Aneurysm 2.1. H: Aneurysm 2.2 is identified during endoscopic procedure and clipped. I: Endoscopic clipping of Aneurysm 2.2. J: Incomplete clipping is discovered during exploration and endoscopic re-clipping of Aneurysm 2.2 is performed. K: Adjustment of the aneurysm clip to ensure complete occlusion of Aneurysm 2.2. L: Confirmation of complete clipping by dissecting the aneurysm body under endoscopic visualization. M: Dissection of the carotid artery region in preparation for clipping the second aneurysm (Aneurysm 2.2). N: Exposure of the A1 segment aneurysm(black arrow) under endoscopic visualization(Aneurysm 2.2). O: Clipping of Aneurysm 2.2. P: Step 3: Removal of the bone flap, including the large bone flap used for decompression(red arrow) and the small bone flap(black arrow) during endoscopic surgery. Q: Postoperative CT scan shows favorable outcomes. R: Postoperative CT scan demonstrates ideal hematoma clearance. S: Consciousness recovery, with normal left-sided limb function. T: Right-sided limb function recovers to grade three before discharge.\u003c/p\u003e","description":"","filename":"Figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/81ae3f04c857f872c9942d70.png"},{"id":56884175,"identity":"35f7e1c7-f514-4c24-8ca7-6916258ad9ab","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":672855,"visible":true,"origin":"","legend":"\u003cp\u003eA: Minimal bleeding on admission. B: Preoperative CTA showing a giant vascular malformation. C: Acute hydrocephalus following conservative treatment. D: Emergency external ventricular drainage and partial embolization of the vascular malformation. E: Postoperative CT showing favorable results. F: Consciousness decline 10 days after embolization. G: Opening the dura reveals a large vascular malformation after embolization. H: Endoscopic evacuation of the hematoma and occlusion of partially supplying arteries. I: Midline structure regression observed after endoscopic procedure. J: Follow-up visit after two months showing good recovery.\u003c/p\u003e","description":"","filename":"Figure9.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/4ed9b68df8e0578138fd8769.png"},{"id":56884174,"identity":"8c12acbf-0efe-4de4-bf34-602e2ff980e9","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":1878025,"visible":true,"origin":"","legend":"\u003cp\u003eA\u0026amp;B: Preoperative CT showing temporal lobe hematoma. C\u0026amp;D: Preoperative CTA revealing vascular malformation and arteriovenous fistula. E\u0026amp;F: Measurement with a caliper for precise localization of the hematoma and design of a minimally invasive incision. G: Opening the dura reveals an abnormal vascular cluster. H: Endoscopic evacuation of the hematoma. I: Exposure of the venous varix. J: Excision of the vascular malformation cluster. K\u0026amp;L: Postoperative CT showing excellent results. M: Postoperative CTA demonstrating complete removal of the vascular malformation. N: Preoperative hematoma volume of 38.6 ml. O: Postoperative hematoma volume of 0.6 ml, with a clearance rate of 98.4%. P: Favorable postoperative condition.\u003c/p\u003e","description":"","filename":"Figure10.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/f52c1c671ac1143605b1b06f.png"},{"id":56884172,"identity":"9799a9f3-a941-445d-a04c-ac60897ac20a","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":1510947,"visible":true,"origin":"","legend":"\u003cp\u003eA: Preoperative CT showing right temporal-parietal lobe hemorrhage with extension into the ventricle. B: Curvilinear skin incision line in the right temporal-parietal region. C: Neuroendoscopic exploration revealing hematoma located in the right frontal-parietal and basal ganglia regions. D: Postoperative CT demonstrating hematoma clearance. E: Postoperative CTA indicating findings suggestive of Moyamoya disease. F: Postoperative CT at 10 days showing ideal hematoma clearance.\u003c/p\u003e","description":"","filename":"Figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/fe72ce719cf26a55a264dbeb.png"},{"id":56884420,"identity":"a0ff2eae-eb7c-4a00-ae2c-1c19ba9d7063","added_by":"auto","created_at":"2024-05-21 17:56:19","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":815179,"visible":true,"origin":"","legend":"\u003cp\u003eNeuroendoscopic minimally invasive surgery for acute cerebral contusion Subdural with intracerebral hematoma; A: Admission CT findings indicate cortical contusion injury. B: CT scan upon admission reveals the presence of a subdural hematoma. C: Significant midline shift and hematoma enlargement observed following conservative treatment. D: Hematoma enlargement demonstrated on CT scan after conservative treatment. E: Selection of a minimally invasive surgical incision line for the neuroendoscopic procedure. F: Neuroendoscopic evacuation of the hematoma. G: Hemostasis performed using a neuroendoscope. H: Postoperative CT scan illustrating midline retraction. I: Satisfactory clearance of the hematoma evident in the postoperative image. J: Postoperative CT scan demonstrates ideal clearance of the hematoma. J: Recovery of consciousness and overall good condition observed after surgery.\u003c/p\u003e","description":"","filename":"Figure12.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/e9fc884daa1172520a522b86.png"},{"id":56884177,"identity":"dc987f58-fc04-430e-9bc5-7e802c9987da","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":13,"title":"Figure 13","display":"","copyAsset":false,"role":"figure","size":1244037,"visible":true,"origin":"","legend":"\u003cp\u003eNeuroendoscopic treatment of an acute epidural hematoma: A: Initial CT scan upon admission revealed a small epidural hematoma. B: Hematoma enlargement observed after conservative treatment. C: Comparison of the modified neuroendoscopic approach (solid line) with the traditional coronal skin incision (dotted line) shows a significant reduction in surgical length. D: Neuroendoscopic removal of the hematoma. E: Extraction of broken fracture fragments using a neuroendoscope. F: Hemostasis performed using a neuroendoscope. G: Suspension of the dura mater following subdural exploration. H: Postoperative CT scan demonstrating complete removal of the hematoma. I: Patient experienced a rapid recovery following the operation.\u003c/p\u003e","description":"","filename":"Figure13.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/183ad861046d8d581e4d3779.png"},{"id":56884173,"identity":"e13365c5-3fcc-43c4-8854-ea175b386353","added_by":"auto","created_at":"2024-05-21 17:48:19","extension":"png","order_by":14,"title":"Figure 14","display":"","copyAsset":false,"role":"figure","size":1385339,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical treatment of midbrain aqueduct hematoma with Acute obstructive hydrocephalus A: CT scan in the local hospital revealed a high-density shadow in the upper part of the aqueduct, indicating the possibility of hematoma or tumor. B: CT scan in the local hospital demonstrated significant hydrocephalus. C: Admission CT scan displayed midbrain aqueductal pathology and acute hydrocephalus. D: CT scan confirmed the presence of significant hydrocephalus. E: Minimally invasive incision line along the coronal suture. F: Visualization of blood-like cerebrospinal fluid upon entering the ventricle, with unclear interventricular foramen structure. G: Performance of third ventriculostomy. H: Enlargement of the stoma to more than 5mm. I: Further dissection of the Liliequist membrane to access the prepontine cistern (black arrow). J: Exploration revealing a blood clot obstructing the opening of the midbrain aqueduct. K: Removal of the blood clot and opening of the midbrain aqueduct. L: Identification of abnormal tissue on the lateral ventricular wall due to the unavailability of preoperative CTA examination.\u003c/p\u003e\n\u003cp\u003eM: Re-exploration of the interventricular foramen before concluding the surgery. N: Presence of a blood clot at the midbrain aqueduct. O: Total surgical duration of 48 minutes. P: Postoperative CT scan demonstrating the disappearance of the high-density shadow in the upper part of the aqueduct. Q: Postoperative CT scan displaying significant improvement in hydrocephalus. R: Recovery of consciousness on the second day after surgery.\u003c/p\u003e","description":"","filename":"Figure14.png","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/e9a3a58764890ea9a326a3de.png"},{"id":63852541,"identity":"3209f650-9899-4ab0-886d-0c73b66510f7","added_by":"auto","created_at":"2024-09-03 04:32:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":24479639,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4356620/v1/e88c05c6-7de4-4e8b-8f28-663de8a49695.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Neuroendoscopy in Acute and Severe Neurological Diseases: A Promising Approach for Improved Patient Outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeuroendoscopy involves utilizing minimally invasive neuroendoscopic(MIN) techniques in neurosurgery for both diagnosing and treating various neurological diseases\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. This MIN surgical technique offers a unique approach to accessing and treating intracranial pathologies with precision and minimal trauma to surrounding tissues\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Neuroendoscopy has shown positive outcomes in intracranial hemorrhages, such as intraventricular hemorrhage (IVH) and subdural hematoma (SDH)\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Traditional methods involved using open craniotomy procedures to remove blood clots; however, advancements in neuroendoscopic techniques now enable less invasive way to clear hematomas. This reduces the chances of complications and enhances patient recovery time\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNeuroendoscopy has recently gained significant attention and now widely used in the treatment of neurological. This innovative method has revolutionized neurosurgery by offering less invasive techniques that lead to improved patient outcomes\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. However, the utilization of a neuroendoscope in patients with severe neurological diseases remains limited, with only a few reported cases\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Many neurosurgeons remain hesitant to incorporate a neuroendoscope in the management of acute and severe neurological conditions.\u003c/p\u003e \u003cp\u003eCurrently, the application scope of neuroendoscopy primarily includes three aspects: ventricular endoscopy, initially less common but now an integral part of the technique; transsphenoidal endoscopy, currently the primary application field; and the emerging trend of transcranial endoscopy, which holds promise for the future.\u003c/p\u003e \u003cp\u003eFrom September 2016 to December 2023, we have successfully applied neuroendoscopic technique in 815 cases of acute and severe cases. Among which 474 cases of cerebral hemorrhage (180 cases of Basal ganglia cerebral hemorrhage; 100 cases of Thalamic hemorrhage; 80 Cerebral lobe hemorrhage; 58 Brain stem hemorrhage; 40 cases of Ventricular hemorrhage; 26 cases of Cerebellar hemorrhage), Hemorrhagic cerebrovascular diseases (210 cases of aneurysm, 24 cases of vascular malformation, 4 cases of arteriovenous fistula, 10 cases of moyamoya disease complicated with hemorrhage), craniocerebral injury(32 cases of epidural hematoma and 46 cases of contusion and laceration with intracerebral hematoma) and 15 cases of acute hydrocephalus.\u003c/p\u003e \u003cp\u003eThis article aims to explore the growing role of neuroendoscopy in the management of various acute and severe neurological diseases, highlighting its efficacy, safety, and future prospects.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study included a total of 815 patients by a neuroendoscopic approach in our department between September 2016 to December 2023. The aim of this study was to retrospectively investigate the data of patients with Acute and Severe neurological disease. There were 556 males and 269 females, and the age ranged from 28 to 83 years (mean 54.6 years). Preoperative computed tomography (CT) scans were carried out in all the patients to rule out neoplasia or other intracranial disease,\u003c/p\u003e \u003cp\u003eThe study protocol was approved by the Ethics Committee of our hospital (WDRY2022-K099), and Informed consent was obtained from all patients or their legal guardians for the publication of any identifying information or images in an online open-access publication. Patient confidentiality and privacy were maintained throughout the process in accordance with ethical guidelines and institutional policies. The inclusion criteria were as follows: ① patients with Intracerebral Hemorrhage; ② patients with Hemorrhagic cerebrovascular diseases; ③ patients with Intracranial aneurysm; ④ patients with craniocerebral injury; and ⑤ patients with acute hydrocephalus;. The exclusion criteria were as follows: ① conservative treatment without surgery; ② chronic patients; ③ conservative drug treatment; and; ④ incomplete follow-up data.\u003c/p\u003e \u003cp\u003eWe studied 815 cases of Acute and Severe neurological disease who underwent neuroendoscopic approach in our department within the period between September 2016 to December 2023 at our hospital. Patients were divided into four categories: there were 474 cases of cerebral hemorrhage, 248 cases of Hemorrhagic cerebrovascular diseases, 78 cases of craniocerebral injury and 15 cases of acute hydrocephalus (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and Characteristics of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubtypes Included\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebral Hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBasal Ganglia: 180, Thalamic: 100, Cerebral Lobe: 120, Brain Stem: 48 ,Ventricular: 40, Cerebellar: 26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemorrhagic Cerebrovascular Diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAneurysm: 210, Vascular Malformation: 24, Arteriovenous Fistula: 4, Moyamoya Disease with Hemorrhage: 10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute and subacute Craniocerebral Injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEpidural Hematoma: 32, Contusion and Laceration with Intracerebral Hematoma: 46,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute Hydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the distribution of patients across different categories based on their presenting conditions. Cerebral hemorrhage was the most common condition, followed by hemorrhagic cerebrovascular diseases, craniocerebral injury, and acute hydrocephalus.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eOperative technique\u003c/h2\u003e \u003cp\u003eThe minimally invasive neuroendoscopic (MIN) technique was employed under general anesthesia for patients with acute and severe neurological diseases. The positioning and incision approach varied based on each neurological condition. To ensure optimal access and minimize potential complications, the patient was positioned accordingly, such as in a supine position with a slightly elevated head to aid venous drainage and reduce brain swelling. The scalp incision was made over the planned entry point, and careful measures were taken to preserve surrounding structures while creating a burr hole or minicraniotomy using a high-speed drill.\u003c/p\u003e \u003cp\u003eThe dura is carefully opened in a cruciate manner using either scissors or a scalpel. The resulting dural flaps are gently retracted, allowing for exposure of the surgical site. In order to visualize the area, a rigid endoscope with a 0\u0026deg; or 30\u0026deg; angle (such as the Karl Storz endoscope from Germany) is inserted into the space created by the hematoma. Continuous irrigation is applied to ensure a clear surgical field, while suction is utilized as needed to remove any blood and debris from the area.\u003c/p\u003e \u003cp\u003eUnder direct endoscopic visualization, the cerebral contusion or laceration and hematoma are meticulously removed, gentle manipulation and suctioning are performed to evacuate the hematoma while minimizing damage to surrounding healthy tissue. Any visible bleeding was managed using a bipolar coagulator with low output power. Hemostasis is achieved meticulously to prevent re-bleeding and minimize postoperative complications. Following hematoma evacuation, a soft catheter is carefully inserted into the hematoma cavity to drain any remaining liquid hematoma and the catheter is secured and connected to a closed drainage system to monitor and control postoperative drainage. The dura is closed using a standard technique, ensuring watertight closure. The bone flap is repositioned and fixated using miniplates and screws. The scalp incision is closed in layers, ensuring hemostasis and proper wound approximation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eDemographics and other characteristics\u003c/h2\u003e\n \u003cp\u003eIn our study there are of 815 patients, among which 556 males and 269 females(ranged from 28 to 83 years). All patients underwent surgery within 72 hours. we divided patient into four categories based on their conditions: 474 cases of cerebral hemorrhage, 248 cases of hemorrhagic cerebrovascular diseases, 78 cases of craniocerebral injury, and 15 cases of acute hydrocephalus (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe neurological status of the patients was evaluated using the Glasgow Coma Scale (GCS) scores. For each neurological condition, the complete hematoma clearance rates rate was more than 90%. Furthermore, we saw higher GCS scores at discharge, which suggests better neurological function and possible recovery.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e1. Cerebral hemorrhage\u003c/h2\u003e\n \u003cp\u003e1.1 Cerebral hemorrhage in basal ganglia\u003c/p\u003e\n \u003cp\u003eA 50-year-old man was brought to our department after undergoing emergency drilling and drainage locally for cerebral hemorrhage management. Upon arrival, he was conscious with equal-sized and round pupils, but unresponsive to light. He also had complete left limb weakness.\u003c/p\u003e\n \u003cp\u003eA CT scan revealed cerebral hemorrhage in the right basal ganglia, insula, temporal lobe, along with subarachnoid hemorrhage post-drainage. Given the potential advantages of neuroendoscopy, we opted for this approach to maximize hematoma removal. The procedure provided excellent maneuverability, achieving a 94% clearance rate. Overall, the surgery yielded satisfactory results, with the patient showing significant improvement(Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThis case underscores the effectiveness of neuroendoscopy in intricate cerebral hemorrhage cases, offering high clearance rates and favorable clinical outcomes.\u003c/p\u003e\n \u003cp\u003e1.2 Thalamic Hemorrhage\u003c/p\u003e\n \u003cp\u003eA 69-year-old man was admitted to our hospital after being discovered unconscious for two hours while showering. A head CT scan showed a left thalamic hemorrhage and bleeding into the right lateral ventricle. The patient presented with a low level of consciousness and unequal pupil sizes, with the left pupil being larger than the right. The pupillary light reflex was slow. The hemorrhage in the thalamus and brainstem caused hydrocephalus, which was life-threatening. A successful minimally invasive neuroendoscopic surgery called \u0026quot;sheath within sheath\u0026quot; was performed, removing 97% of the hematoma(Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The procedure\u0026apos;s results are promising, giving him hope for a full recovery.\u003c/p\u003e\n \u003cp\u003e1.3 Cerebral Lobe Hemorrhage\u003c/p\u003e\n \u003cp\u003eA 60-year-old woman experienced dizziness and discomfort in the morning, which persisted despite rest. A head CT scan revealed a hemorrhage in the left parietal lobe. The patient also suffered from recurrent vomiting. Since the onset of symptoms, the patient has been in a shallow coma and unable to orally consume fluids. She has a urinary catheter in place and functioning properly. Her Glasgow Coma Scale (GCS) score is 7, and both pupils are equal in size, approximately 2 mm in diameter, with no response to light. The preoperative hematoma volume was measured at 40.3 ml, which significantly decreased to 0.6 ml after surgery. Impressively, the hematoma clearance rate reached 98.5% using 3D-slice software. The patient\u0026apos;s recovery has been excellent(Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e1.4 Brainstem Hemorrhage\u003c/p\u003e\n \u003cp\u003e52-year-old female patient was admitted to our department in a comatose state. Her examination revealed bilateral enlarged pupils, partially open eyes with tingling pain, and an absence of response to stimuli. In moreover, the patient experienced limb tingling and buckling, as well as neck stiffness. A CT scan showed the presence of a pontine and subarachnoid hemorrhage.. we employed a \u0026quot;2-in-1\u0026quot; surgical technique. This procedure involved two key steps. The first step involved puncture drainage, which facilitated rapid hypotension. This approach aimed to swiftly and completely reduce intracranial pressure(ICP), which is especially crucial in cases of brain stem hematomas. The second step was endoscopic removal of the hematoma, utilizing the advantages of minimally invasive surgery. After the surgical intervention, postoperative CT revealed a hematoma clearance rate of 83.5%. Although not achieving complete clearance, the outcome was still considered satisfactory(Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e), considering the challenging nature of the brain stem hemorrhage. This case highlights the application of a combined surgical technique and concept to effectively manage pontine hemorrhages. The use of rapid hypotension and neuroendoscopy played crucial roles in the treatment, allowing for significant reduction in hematoma size and improvement in the patient\u0026apos;s condition.\u003c/p\u003e\n \u003cp\u003e1.5 Intraventricular hemorrhage\u003c/p\u003e\n \u003cp\u003eA 55 years old Female was admitted to our hospital with clear consciousness but in poor spirits. CT scan revealed intraventricular hematoma. The patient underwent minimally invasive neuroendoscopic surgery, which was performed with a unilateral approach to remove bilateral lateral ventricle and third ventricle hematomas simultaneously. This technique allowed us to achieve precise visualization and targeted removal of the hematomas within the ventricular system. Postoperatively, there was a remarkable improvement in the patient\u0026apos;s condition. The patient regained consciousness the very next day after the procedure, indicating a positive outcome. The result of the surgery was satisfactory(Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e1.6 Cerebellar Hemorrhage\u003c/p\u003e\n \u003cp\u003eA 72-year-old woman was brought to our department in a comatose state (GCS 6, E1V2M3), with equal and reactive pupils measuring 2 mm. She was presented with an unexpected loss of consciousness. A CT scan revealed a large right cerebellar hemorrhage that extended into the ventricle. The preoperative hematoma volume was significant, at around 41.9 ml, with the hematoma spreading across the midline and putting pressure on the brainstem, posing a life-threatening situation. The patient had neuroendoscopic minimally invasive surgery, which resulted in a 91.2% hematoma clearance rate. The results are encouraging, raising hopes for her recovery(Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e. \u003cstrong\u003eHemorrhagic Cerebrovascular Diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e2.1(a) Clipping of Anterior communicating artery aneurysm by eyebrow arch keyhole approach\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003eA 42 years old male was admitted to our hospital due to a headache lasting for 4 hours. On admission, a CT scan revealed subarachnoid hemorrhage, and a preoperative CT angiography (CTA) showed an anterior communicating artery aneurysm. The patient underwent neuroendoscopic minimally invasive clipping of the anterior communicating artery aneurysm using the supraorbital keyhole approach. The aneurysm was successfully clipped during the procedure. On the three-month follow-up examination after the surgery, the patient showed a good recovery(Fig. \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e2.1(b) The neuroendoscopic \u0026quot;three-in-one\u0026quot; procedure was successfully performed on aneurysms and giant hematoma\u003c/p\u003e\n \u003cp\u003eA 49-year-old female patient was admitted to our hospital in a deeply comatose state with dilated pupils on one side. Prior to surgery, both pupils exhibited dilation. Diagnostic imaging revealed a massive hematoma in the left basal ganglia region on CT scan, while CTA demonstrated an aneurysm located in the middle cerebral artery and A1 segment.\u003c/p\u003e\n \u003cp\u003eTo address these critical conditions, a \u0026quot;Three-in-One\u0026quot; surgical technique and concept were employed, aiming to remove the hematoma and clip the aneurysm:\u003c/p\u003e\n \u003cp\u003eStep one involved rapid decompression through puncture and drainage, resulting in a prompt reduction of blood pressure. This initial step was crucial in stabilizing the patient\u0026apos;s condition.\u003c/p\u003e\n \u003cp\u003eIn step two, the hematoma was meticulously removed using an endoscopic approach, and the aneurysm was successfully clipped, preventing further complications.\u003c/p\u003e\n \u003cp\u003eStep three consisted of the removal of the bone flap, further optimizing the surgical outcome.\u003c/p\u003e\n \u003cp\u003eFollowing the procedure, the patient exhibited a remarkable recovery. Consciousness was regained, and the left limbs demonstrated normal functionality. The muscle strength in the right limbs improved to grade 3, indicating significant progress. Ultimately, the patient was discharged successfully, having achieved a favorable outcome(Fig. \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e2.2 Vascular Malformation\u003c/p\u003e\n \u003cp\u003eA 28-year-old male presented with spontaneous intraventricular hemorrhage and was admitted to the hospital. CTA revealed a giant vascular malformation. Preoperatively, the patient developed hydrocephalus and underwent emergency external ventricular drainage followed by interventional treatment. Partial embolization of the vascular malformation was performed under the premise of safety.\u003c/p\u003e\n \u003cp\u003eTen days postoperatively, the patient experienced bleeding, which was managed by endoscopic evacuation of the hematoma and occlusion of the partially supplying arteries. The patient had a smooth recovery and was discharged. Follow-up examination two months later showed favorable outcomes(Fig. \u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e2.3 Arteriovenous Fistula\u003c/p\u003e\n \u003cp\u003eA 60-year-old male patient suddenly experienced pain and vomiting for no apparent reason about 8 hours ago. CT scan revealed a hemorrhage in the left temporal lobe. Preoperative CTA revealing vascular malformation and arteriovenous fistula. The patient underwent a minimally invasive neuroendoscopic surgery to remove the hematoma and correct the vascular malformation. The surgery achieved an impressive hematoma clearance rate of 98.4%. After the procedure, the patient recovered well(Fig. \u003cspan class=\"InternalRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e2.4 Moyamoya Disease with Hemorrhage\u003c/p\u003e\n \u003cp\u003eA 48-year-old woman with a history of hypertension was admitted to the hospital after developing sudden aphasia, left upper limb weakness, vomiting, and coma. A head CT scan revealed a hemorrhage in the right temporal-parietal lobe that spread into the ventricle. The patient also had stage 3 hypertension and signs of impending brain herniation. To treat the intraventricular hemorrhage, the patient had neuroendoscopic surgery. Postoperative CTA results indicated the presence of Moyamoya disease. However, the patient demonstrated improved consciousness and a successful surgical outcome(Fig. \u003cspan class=\"InternalRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e3. Craniocerebral Injury\u003c/h2\u003e\n \u003cp\u003e3.1 Neuroendoscopic minimally invasive surgery for acute cerebral contusion and laceration subdural with intracerebral hematoma\u003c/p\u003e\n \u003cp\u003eA 33-year-old female with drowsiness and altered consciousness was admitted to our hospital 7 hours after a traumatic car accident. CT scan revealed a left temporal lobe contusion injury, subdural hematoma at the frontal-temporal vertex of the left side, and subarachnoid hemorrhage. the patient underwent neuroendoscopic evacuation of the intracerebral hematoma. This surgical intervention utilized a neuroendoscope to meticulously remove the hematoma from within the brain. The patient regained consciousness the second day after surgery(Fig. \u003cspan class=\"InternalRef\"\u003e12\u003c/span\u003e), and the overall outcome was favorable.\u003c/p\u003e\n \u003cp\u003e3.2 Neuroendoscopic modified surgical approach for acute epidural hematoma and brain contusion\u003c/p\u003e\n \u003cp\u003eA 49 years old male suffered from \u0026quot;Head and facial trauma with temporary disturbance of consciousness for 7 hours\u0026quot; admitted in our ward. He was delirious and had a right frontal small epidural hematoma. After 6 hours of conservative treatment, the patient\u0026apos;s level of consciousness deteriorated further, and a CT scan revealed the enlargement of the hematoma.. An emergency hematoma removal surgery was performed under neuroendoscopic approach, which allowed for precise visualization and removal of the hematoma. The patient regained consciousness and recovered after surgery(Fig. \u003cspan class=\"InternalRef\"\u003e13\u003c/span\u003e). The successful outcome demonstrates the benefits of utilizing neuroendoscopy for emergent cases of hematoma removal, improving patient prognosis and overall recovery.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e4. Acute Hydrocephalus\u003c/h2\u003e\u003cspan\u003e\n \u003cp\u003e4.1 Surgical treatment of midbrain aqueduct hematoma with Acute obstructive hydrocephalus\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003eA 78-year-old female patient was admitted to our department in critical condition after presenting with coma. A preoperative CT scan showed hydrocephalus and a high-density shadow in the third ventricle. The patient underwent an emergency neuroendoscopic procedure overnight, which included creating a ventriculostomy at the ventricular floor, investigating abnormalities in the shunt system, and removing the hematoma. The patient regained consciousness the second day following surgery, and the overall outcome was positive(Fig. \u003cspan class=\"InternalRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eNeuroendoscopy has emerged as an effective minimally invasive technique for treating acute and severe neurological diseases. This approach has several advantages over traditional open surgery, including less trauma to surrounding tissues, faster recovery times, and lower complication rates\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Neuroendoscopy has demonstrated promise in improving patient outcomes in acute conditions such as traumatic brain injury, intracerebral hemorrhage, and severe hydrocephalus\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOne of the primary advantages of neuroendoscopy is its ability to provide direct visualization and access to deep-seated lesions or areas that are difficult to reach using traditional surgical methods\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. This precise targeting can result in more effective lesion removal, better decompression of brain structures, and improved cerebrospinal fluid flow\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In patients undergoing neuroendoscopic procedures for conditions such as intraventricular hemorrhage evacuation and tumor resection, studies have reported favorable outcomes in terms of reduced morbidity and mortality rates\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, neuroendoscopy allows surgeons to assess tissue and fluid dynamics in real time, allowing them to make informed decisions and adjust their approach throughout the procedure\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. The dynamic nature of neuroendoscopic surgery can be especially useful in acute settings where prompt intervention is critical for patient survival and recovery. Despite the numerous benefits of neuroendoscopy, there are some challenges and limitations that must be addressed. These include the learning curve required to master neuroendoscopic techniques, the availability of specialized equipment and trained personnel, and the need for additional research to determine the long-term efficacy and safety of neuroendoscopic procedures in acute and severe neurological diseases. However, it may not be suitable for patients with skull fractures, multiple contusions, or those requiring decompressive craniectomy. Furthermore, the emergence of neuroendoscopy signifies not merely a passing trend, but rather the dawn of a new era in neurosurgery.\u003c/p\u003e \u003cp\u003eFinally, neuroendoscopy looks very promising as a useful tool in the treatment of acute and severe neurological diseases. Future research should focus on optimizing surgical techniques, patient selection criteria, and long-term outcomes to further establish the role of neuroendoscopy in improving patient care.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe minimally invasive neuroendoscopic (MIN) approach for hematoma evacuation in acute and severe neurological diseases offers a safe and effective alternative to conventional open procedures. This technique allows for meticulous hematoma removal, precise hemostasis, and optimal visualization, with the added benefits of reduced surgical trauma and faster recovery. Proper patient selection and surgeon expertise are essential for achieving successful outcomes using this minimally invasive approach.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMIN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eminimally-invasive neurosurgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintraventricular hemorrhage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecraniocerebral injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlasgow Coma Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eintracerebral hematoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography angiography.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e The datasets generated and/or analyzed during the current study are not publicly available due to the need to protect patient privacy. Access to the data can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u0026nbsp;\u003c/strong\u003eZohaib Shafiq, Zhiyang Li, Pan Lei were responsible for article design and draft writing; Ping Song, Long Zhou were responsible for data collection and processing, and Qiang Cai completed the review of the article. All authors gave final approval of the manuscript to be published.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This work was supported by the National Natural Science Foundation of China (82271518, 81971158, 81671306).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003eThis study was approved by the ethics committee of Renmin Hospital of Wuhan University. All procedures performed in \u0026nbsp;studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e Informed consent was obtained from all patients or their legal guardians for the publication of any identifying information or images in an online open-access publication. Patient confidentiality and privacy were maintained throughout the process in accordance with ethical guidelines and institutional policies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests and none of the material in the paper has been published or is under consideration for publication elsewhere.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLi, K., Nelson, C., Suk, I., \u0026amp; Jallo, G. (2005). Neuroendoscopy: past, present, and future. Neurosurgical Focus, 19(6), E1. https://doi.org/10.3171/FOC.2005.19.6.2\u003c/li\u003e\n \u003cli\u003eGrunert, P., Gaab, M., Hellwig, D., \u0026amp; Oertel, J. (2009). German neuroendoscopy above the skull base. Neurosurgical Focus, 27(3), E7. https://doi.org/10.3171/2009.6.FOCUS09123\u003c/li\u003e\n \u003cli\u003eShim, K., Park, E., Kim, D., \u0026amp; Choi, J. (2017). Neuroendoscopy: Current and Future Perspectives. Journal of Korean Neurosurgical Society, 60, 322-326. https://doi.org/10.3340/jkns.2017.0202.006\u003c/li\u003e\n \u003cli\u003eLi, Y., Zhang, H., Wang, X., She, L., Yan, Z., Zhang, N., Du, R., Yan, K., Xu, E., \u0026amp; Pang, L. (2013). Neuroendoscopic Surgery versus External Ventricular Drainage Alone or with Intraventricular Fibrinolysis for Intraventricular Hemorrhage Secondary to Spontaneous Supratentorial Hemorrhage: A Systematic Review and Meta-Analysis. PLoS ONE, 8. https://doi.org/10.1371/journal.pone.0080599\u003c/li\u003e\n \u003cli\u003eLongatti, P., \u0026amp; Basaldella, L. (2013). Endoscopic management of intracerebral hemorrhage. World neurosurgery, 79(2 Suppl), S17.e1-7. https://doi.org/10.1016/j.wneu.2012.02.025\u003c/li\u003e\n \u003cli\u003eIchimura, S., Takahara, K., Nakaya, M., Yoshida, K., Mochizuki, Y., Fukuchi, M., \u0026amp; Fujii, K. (2019). Neuroendoscopic hematoma removal with a small craniotomy for acute subdural hematoma. Journal of Clinical Neuroscience, 61, 311-314.\u003c/li\u003e\n \u003cli\u003eKarakhan, V. B., \u0026amp; Khodnevich, A. A. (1994). Endoscopic surgery of traumatic intracranial haemorrhages. In Minimally Invasive Neurosurgery II (pp. 84-91). Springer Vienna.\u003c/li\u003e\n \u003cli\u003eKawasaki, T., Kurosaki, Y., Fukuda, H., Kinosada, M., Ishibashi, R., Handa, A., ... \u0026amp; Yamagata, S. (2018). Flexible endoscopically assisted evacuation of acute and subacute subdural hematoma through a small craniotomy: preliminary results. Acta neurochirurgica, 160, 241-248.\u003c/li\u003e\n \u003cli\u003eZhang, Y., Shan, A., Peng, Y., Lei, P., Xu, J., Zhong, X., \u0026amp; Du, B. (2019). The intra-neuroendoscopic technique (INET): a modified minimally invasive technique for evacuation of brain parenchyma hematomas. World Journal of Emergency Surgery : WJES, 14. https://doi.org/10.1186/s13017-019-0239-0\u003c/li\u003e\n \u003cli\u003eSun, S., Li, Y., Zhang, H., Gao, H., Zhou, X., Xu, Y., Yan, K., \u0026amp; Wang, X. (2020). Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage: a Systematic Review and Meta-Analysis. World neurosurgery. https://doi.org/10.1016/j.wneu.2019.10.115\u003c/li\u003e\n \u003cli\u003eLongatti, P., Martinuzzi, A., Fiorindi, A., Maistrello, L., \u0026amp; Carteri, A. (2004). Neuroendoscopic Management of Intraventricular Hemorrhage. Stroke: Journal of the American Heart Association, 35, e35-e38. https://doi.org/10.1161/01.STR.0000113736.73632.F6\u003c/li\u003e\n \u003cli\u003eIchimura, S., Takahara, K., Nakaya, M., Yoshida, K., Mochizuki, Y., Fukuchi, M., \u0026amp; Fujii, K. (2019). Neuroendoscopic hematoma removal with a small craniotomy for acute subdural hematoma. Journal of Clinical Neuroscience, 61, 311-314.\u003c/li\u003e\n \u003cli\u003eLi, Y., Yang, S., Zhou, X., Lai, R., \u0026amp; Tan, D. (2022). A retrospective cohort study of neuroendoscopic surgery versus traditional craniotomy on surgical success rate, postoperative complications, and prognosis in patients with acute intracerebral hemorrhage. Computational intelligence and neuroscience, 2022.\u003c/li\u003e\n \u003cli\u003eEnchev, Y., \u0026amp; Oi, S. (2008). Historical trends of neuroendoscopic surgical techniques in the treatment of hydrocephalus. Neurosurgical Review, 31, 249-262. https://doi.org/10.1007/s10143-008-0131-y.\u003c/li\u003e\n \u003cli\u003eOi, S., Hidaka, M., Honda, Y., Togo, K., Shinoda, M., Shimoda, M., Tsugane, R., \u0026amp; Sato, O. (1999). Neuroendoscopic surgery for specific forms of hydrocephalus. Child\u0026apos;s Nervous System, 15, 56-68. https://doi.org/10.1007/s003810050330.\u003c/li\u003e\n \u003cli\u003eAbd-El-Barr, M., \u0026amp; Cohen, A. (2013). The origin and evolution of neuroendoscopy. Child\u0026apos;s Nervous System, 29, 727-737. https://doi.org/10.1007/s00381-013-2055-2.\u003c/li\u003e\n \u003cli\u003eCinalli, G., Cappabianca, P., Falco, R., Spennato, P., Cianciulli, E., Cavallo, L., Esposito, F., Ruggiero, C., Maggi, G., \u0026amp; Di Ieva, A. (2005). Current state and future development of intracranial neuroendoscopic surgery. Expert Review of Medical Devices, 2, 351-373. https://doi.org/10.1586/17434440.2.3.351.\u003c/li\u003e\n \u003cli\u003eNagasaka, T., Tsugeno, M., Ikeda, H., Okamoto, T., Inao, S., \u0026amp; Wakabayashi, T. (2011). Early recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula: preliminary study in comparison with craniotomy. Journal of Stroke and Cerebrovascular Diseases, 20(3), 208-213. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.11.021.\u003c/li\u003e\n \u003cli\u003eGiannetti, A., Alvarenga, A., Lima, T., Pedrosa, H., \u0026amp; Souweidane, M. (2015). Neuroendoscopic biopsy of brain lesions: accuracy and complications. Journal of Neurosurgery, 122(1), 34-39. https://doi.org/10.3171/2014.9.JNS132648.\u003c/li\u003e\n \u003cli\u003eJim\u0026eacute;nez-V\u0026aacute;zquez, O., \u0026amp; Nagore, N. (2008). The impact of neuroendoscopy in the emergency setting\u0026mdash;A retrospective study of imaging, intraoperative findings, and surgical outcome in 55 patients. Clinical Neurology and Neurosurgery, 110, 539-543. https://doi.org/10.1016/j.clineuro.2008.02.019.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"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":"Acute and Severe neurological disease, Neuroendoscopic approach, Minimally invasive neuroendoscopic, 3D-Slicer+MosoCam/Sina","lastPublishedDoi":"10.21203/rs.3.rs-4356620/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4356620/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To investigate the utilization, effectiveness, and safety of neuroendoscopy in the treatment of acute and severe neurological conditions and to evaluate the clinical outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Between September 2016 to December 2023, a total of 815 patients with acute and severe neurological disease treated by transcranial neuroendoscopic approach were retrospectively reviewed in our department.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among the 815 acute and severe cases, 474 cases of acute cerebral hemorrhage, 248 cases of hemorrhagic cerebrovascular diseases, 78 cases of craniocerebral injury and 15 cases of acute hydrocephalus. The outcomes of our neuroendoscopic surgery were satisfactory without any severe complications and the procedure was life-saving and showed promising outcomes in terms of patient safety and recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e While neuroendoscopy represents a promising approach in the treatment of some acute and severe neurological disease, ongoing research and technological advancements are necessary to optimize its utility and ensure its widespread adoption. This article aims to provide a comprehensive overview of the current state of neuroendoscopy in acute and severe neurological diseases, underscoring its potential to improve patient outcomes and quality of care in neurosurgical practice.\u003c/p\u003e","manuscriptTitle":"Neuroendoscopy in Acute and Severe Neurological Diseases: A Promising Approach for Improved Patient Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-21 17:48:14","doi":"10.21203/rs.3.rs-4356620/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":"1397b5ed-8d55-482b-a826-3cc023a6390c","owner":[],"postedDate":"May 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":31617756,"name":"Health sciences/Neurology/Neurological disorders"},{"id":31617757,"name":"Health sciences/Neurology/Neurological disorders/Brain injuries"}],"tags":[],"updatedAt":"2024-09-03T04:23:51+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-21 17:48:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4356620","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4356620","identity":"rs-4356620","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}