A comment on “Neuroendoscopy for acute severe neurological conditions: high hematoma clearance and rapid recovery in 815 patients – cohort study”
Year: 2026
Type: article
Abstract: Dear Editor, We recently read the article “Neuroendoscopy for Acute Severe Neurological Conditions: High Hematoma Clearance and Rapid Recovery in 815 Patients – Cohort Study” authored by Shafiq et al[1]. The authors retrospectively analyzed 815 patients undergoing transcranial burr-hole neuroendoscopic surgery between September 2018 and June 2024, reporting a mean hematoma clearance of 92.3 ± 5.1%, consciousness recovery (Glasgow Coma Scale [GCS] ≥ 9) within 72 h in 89.0% of patients, and severe complications in 3.7%. This large series, together with the practical description of the “Transparent Sheath Endoport,” “Two-in-One,” and “Three-in-One” approaches, provides valuable real-world information for surgeons considering minimally invasive evacuation in neurocritical settings. First, hematoma volumes were quantified using 3D Slicer’s segmentation module, with clearance calculated from preoperative and postoperative CT within 24 h. However, in the illustrative cases, several preoperative volumes are described as “estimated” (e.g., a “giant” hematoma, or a “small” hematoma that enlarged). It would be helpful if the authors could clarify whether cohort-level volumetry was uniformly segmentation-based and whether inter-rater agreement (or repeat measurements) was assessed. In addition, consciousness recovery was defined as GCS ≥9 within 72 h. Because early GCS can be influenced by intubation, sedation, and postoperative neurocritical care practices, readers may appreciate details on how the GCS was scored in mechanically ventilated patients and whether assessments were performed at standardized sedation levels. For the sizeable spontaneous intracerebral hemorrhage subgroup, functional outcomes in contemporary evidence synthesis are often benchmarked with the modified Rankin Scale (mRS) at 90 days, and therefore, providing mRS (or explaining its absence) may facilitate cross-study comparisons. Second, the authors graded complications using the Clavien–Dindo system[2]. We noticed that Table 2 lists cerebrospinal fluid (CSF) leak among minor complications (Grade II), described as self-resolving and not requiring intervention. However, in clinical practice, CSF leaks may occasionally necessitate procedural management (e.g., lumbar drain placement or surgical repair). Clarifying the specific management of these eight CSF leak cases, and providing the full distribution of complication grades across all categories, would help readers better interpret the reported complication rates. Moreover, in neurosurgical populations, neurological deterioration or deficits may be clinically meaningful even when they do not align neatly with intervention-based grading; reporting an additional neurosurgery-specific framework (e.g., the Landriel Ibañez classification)[3] alongside Clavien–Dindo could offer a more granular safety profile. Third, the cohort spans nearly 6 years and includes multiple technical variants. As instrumentation, perioperative protocols, and operator experience may evolve over time, readers would benefit from outcomes stratified by calendar period and/or technique (and, if feasible, adjusted or stratified by baseline severity). Such analyses could help distinguish case-mix effects from procedural refinement and would support reproducibility when translating these results to other centers. Notwithstanding these concerns, we express our sincere appreciation for the authors’ contribution. We trust that these clarifications may further enhance the persuasiveness of the article, and we eagerly anticipate the authors’ response. Authors acknowledge the use of OpenAI’s language model for grammar and language refinement during the writing process[4]. Ethics approval Not applicable. Consent Not applicable.
Source: International Journal of Surgery
Authors: Feng Ye, Xiuping Dong, Hao Liu
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W7125158990