Evidence Update for Minimally Invasive Surgical Evacuation of Supratentorial Spontaneous Intracerebral Hemorrhage

Updated: August 24, 2026
Figure 1: Minimally invasive surgery techniques include (A) tubular retractor with mechanical aspiration, (B) endoscopic evacuation, and (C) stereotactic aspiration, typically combined with adjunctive instillation of thrombolytics, followed by closed-system drainage to gravity over several days. All techniques rely on navigational guidance to preserve brain and white matter tracts. Tubular retractor and endoscopic techniques require a slightly larger device diameter than stereotactic aspiration, but result in immediate evacuation of the hematoma with more rapid reduction of mass effect.
  • More recent clinical trial evidence has rekindled the role of surgical intervention for improving outcomes after spontaneous intracerebral hemorrhage (ICH).
  • Recent advancements in minimally invasive surgical techniques suggest potential improvements in functional recovery, broadening consideration for surgical treatment of certain populations, such as lobar hemorrhage after spontaneous intracerebral hemorrhage.
  • This science advisory provides a summary of the most current randomized evidence for minimally invasive surgical evacuation of ICH compared to medical management, and includes considerations for patient selection, care pathways, and surgical techniques.
Read the full article in Stroke »

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