Comparison of minimally invasive neuroendoscopic evacuation and conventional open surgery for spontaneous cerebellar hemorrhage: a systematic review and meta-analysis.

Spontaneous cerebellar hemorrhage (SCH) is a subtype of intracerebral hemorrhage associated with high morbidity and mortality rates. Although neuroendoscopy (NE) surgery has emerged as a minimally invasive alternative to craniectomy or craniotomy, there is still no consensus regarding the optimal surgical approach. This systematic review and meta-analysis aimed to comprehensively evaluate the comparative efficacy and safety of NE evacuation versus open surgery for the management of SCH. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for randomized controlled trials and observational studies comparing the outcomes of NE evacuation versus open surgery for SCH. Four studies were included, comprising 174 patients, of whom 85 (48.85%) underwent NE surgery, and 89 (51.15%) underwent open surgery. NE demonstrated significantly lower intraoperative blood loss (MD -291.35; 95% CI [-345.59, -237.11]; p < 0.001; I² = 64%), operation time (MD -114.17; 95% CI [-126.23, -102.12]; p < 0.001; I² = 0%), infection (RR 0.35; 95% CI [0.22, 0.56]; p < 0.001; I² = 0%), and cerebrospinal fluid leak rates (RR 0.15; 95% CI [0.03, 0.79]; p = 0.025; I² = 0%) in comparison with open surgery. However, no significant differences between groups were observed for rebleeding, mortality, modified Rankin Scale, hematoma evacuation rate, need for external ventricular drainage (EVD), duration of EVD, and need for shunt procedure. Further research exploring the influence of factors like patient age, hematoma volume, and degree of fourth ventricle compression is needed to better assess the comparative efficacy and safety of both approaches for SCH management.