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Minimally Invasive Surgery for Spontaneous Intracerebral Hemorrhage: Meta-Analysis of High-Quality Randomized
Ahmed Alkhiri1,2, Aser F Alamri3,4, Ahmed A Almaghrabi1,2
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
Annals of Neurology
|October 31, 2024
Summary
Minimally invasive surgery (MIS) improves functional outcomes and reduces mortality for patients with spontaneous intracerebral hemorrhage (ICH). This evidence supports MIS as a primary treatment strategy for ICH management.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Trials
Background:
- Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and morbidity.
- Limited evidence-based therapeutic options exist for ICH management.
Purpose of the Study:
- To evaluate the current evidence for minimally invasive surgery (MIS) in managing ICH.
- To assess the efficacy and safety of MIS compared to traditional treatments.
Main Methods:
- Systematic review and meta-analysis of high-quality randomized clinical trials (RCTs).
- Searched Medline, Embase, Scopus, and Cochrane Library up to April 12, 2024.
- Analyzed primary outcomes: good functional outcome (modified Rankin scale 0-3) and 90-day mortality; secondary outcomes: 30-day mortality and rebleeding.
Main Results:
- Fourteen high-quality RCTs involving 3,027 patients were included.
- MIS demonstrated higher odds of good functional outcome (OR, 1.51) and lower odds of long-term (OR, 0.72) and early mortality (OR, 0.73).
- Rebleeding rates were similar between MIS and control groups (OR, 1.10).
Conclusions:
- High-quality evidence supports MIS as a primary treatment strategy for ICH.
- MIS offers significant benefits in functional recovery and survival for ICH patients.
- Findings were consistent across sensitivity and subgroup analyses, including deep ICH.
