Abstract
OBJECTIVE: To compare the clinical efficacy, neurofactor changes, and prognosis in elderly patients with spontaneous intracerebral hemorrhage (ICH) treated with endoscopic surgery versus conventional craniotomy. METHODS: A retrospective analysis was conducted on 88 elderly patients with spontaneous ICH admitted from July 2021 to April 2024. Based on surgical method, patients were assigned to either the conventional craniotomy group (n=44) or the endoscopic surgery group (n=44). Surgical efficacy (hematoma evacuation rate, surgical duration, intraoperative blood loss), short-term prognosis (ICU stay, hospital stay, GOS, NIHSS, ADL scores), serum neurofactors (SOD, NSE, NGF, BDNF), inflammatory markers (WBC, CRP, PCT), and complication rates were compared. RESULTS: (1) The endoscopic group had significantly shorter surgical time and lower blood loss than the craniotomy group (P<0.05), with similar hematoma evacuation rates (P>0.05). (2) ICU and hospital stays were significantly shorter in the endoscopic group (P<0.05). Postoperative GOS and ADL scores were higher, and NIHSS scores were lower in the endoscopic group at 3 months (P<0.05). (3) Compared with preoperative levels, both groups showed a decreasing trend in SOD and NSE and an increasing trend in NGF and BDNF after surgery, with the observation group showing more significant and sustained changes over time (P < 0.05). (4) Although postoperative inflammatory markers increased in both groups, the observation group had milder elevations and faster downward trends (P < 0.05). (5) The complication rate was lower in the endoscopic group (6.82% vs 22.73%, P<0.05). CONCLUSION: Compared to conventional craniotomy, endoscopic hematoma evacuation in elderly ICH patients results in milder inflammatory responses, more favorable neurofactor changes, fewer complications, and improved recovery. However, these findings require further validation due to the retrospective design and limited sample size.