Analysis of the learning curve for neuroendoscopic evacuation of basal ganglia hemorrhage.

Background: Neuroendoscopic evacuation has become an important minimally invasive approach for the treatment of basal ganglia hemorrhage. However, its technical complexity requires a well-defined learning curve, and evidence regarding learning curve characteristics, particularly among experienced surgeons, remains limited. Objective: To evaluate the learning curve of neuroendoscopic evacuation for basal ganglia hemorrhage and to determine the number of cases required to achieve technical proficiency. Methods: A retrospective analysis was conducted on 120 consecutive patients with basal ganglia hemorrhage who underwent neuroendoscopic evacuation performed by a single experienced neurosurgeon. The learning curve was assessed using cumulative sum (CUSUM) analysis based on operative time. A segmented regression model and a power-law model were applied to characterize the learning curve. Surgical outcomes, hemostasis strategies, and postoperative imaging indicators were compared across different learning phases. Results: The CUSUM analysis identified a clear learning inflection point at approximately the 25th case. Operative time decreased significantly across phases (1.77 ± 0.47 h vs. 1.28 ± 0.40 h vs. 1.23 ± 0.42 h, Conclusion: Significant differences exist in neuroendoscopic evacuation of basal ganglia hematomas across different learning phases. These findings can provide guiding value for clinicians to improve surgical efficiency and quality.