BACKGROUND AND OBJECTIVES: Endoscopic evacuation for spontaneous intracerebral hemorrhage can limit approach-related injury, but hemostasis and visualization within a narrow corridor remain challenging. We evaluated whether a single-surgeon “chopsticks” configuration was associated with improved operative efficiency and early neurological recovery compared with a conventional 2-surgeon, 3-handed technique. METHODS: We performed a single-center retrospective cohort study of supratentorial spontaneous intracerebral hemorrhage treated with endoport-assisted endoscopic evacuation (control, n = 25; chopsticks, n = 20) after excluding structured training-phase cases. Primary outcomes were operative time and estimated blood loss. Early neurological recovery (secondary outcome) was assessed using the Full Outline of UnResponsiveness (FOUR) score on postoperative day 3 (D3) and day 7 (D7) ; ΔFOUR was defined as FOURD7 − FOURD3. Other outcomes were exploratory. RESULTS: Baseline characteristics were similar between groups. Operative time was shorter with the chopsticks configuration (118. 3 ± 14. 8 vs 147. 3 ± 52. 9 minutes; P =. 014), and estimated blood loss was lower (100. 5 ± 30. 1 vs 184. 0 ± 117. 1 mL; P =. 002). Radiographic evacuation efficacy was high in both groups with similar evacuation rate and residual hematoma volume. FOUR improved more from D3 to D7 in the chopsticks group (median IQR 3. 0 2. 0-3. 2 vs 2. 0 1. 0-3. 0; P =. 005). In an intracerebral hemorrhage score-adjusted linear mixed-effects model, the group × time interaction was significant (β = 1. 01; 95% CI 0. 42-1. 60; P =. 001). CONCLUSION: In this pilot cohort, the chopsticks configuration was associated with improved operative efficiency and a steeper early neurological recovery trajectory without differences in gross evacuation extent. Prospective validation is warranted.
Liu et al. (Wed,) studied this question.