Meta-analyses of intracerebral hematoma treatment

The aim of this study is to define the position of surgery preference in the treatment choice for spontaneous intracerebral hematoma (ICH) and to compare the efficacy of surgery with the medical treatment based on data from 18 previously reported randomized prospective studies on this topic.

Literature databases and articles were searched from 1960 to 2010. Eighteen randomized studies on this topic were evaluated.

Among these 18 studies, 7 (38.9%) were multicenter and 11 (61.1%) were single center. Totally 204 centers were involved. 1769 patients were treated surgically and 3200 medically. Craniotomy was the most preferred method (n = 14; 77.8%). Follow-up time was mostly 6 months. In general, the effect of surgical versus medical treatment on outcome (mortality/morbidity) after a supratentorial spontaneous ICH do not differ significantly. In individual analysis, the mortality was found to be significantly lower in the operated group than the nonoperated group in only two studies (Kurtsoy's and Miller's studies). Meta-analysis of subgroup analysis revealed surgical treatment results were significantly better for hematoma volume > 40 ml, early surgery (before 24 hours), and Glasgow Coma Scale (GCS)≥ 6.

Surgical treatment results were found to be superior to medical treatment in cases with hematoma volume > 40 ml, and GCS ≥ 6. The studies are not adequate to analyze the best type of surgery.