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Minimally Invasive Surgery Versus Medical Management for Spontaneous Supratentorial Intracerebral Hemorrhage: An
Mohammed Maan Al-Salihi1, Maryam Sabah Al-Jebur2, Ram Saha3
1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO 65212, USA.
Abstract:
Background and Objectives: Minimally invasive surgery (MIS) has emerged as a less invasive alternative to medical management (MM) in intracerebral hemorrhage (ICH), but its comparative effectiveness remains uncertain. Materials and Methods: We searched PubMed, Web of Science, Scopus, and Cochrane Library for RCTs and prospective matched studies comparing MIS with MM in supratentorial spontaneous ICH. Primary outcomes were functional recovery and mortality; secondary outcomes were adverse events, rebleeding, and ICU stay. Meta-analysis was performed using RevMan 5.4 with 95% confidence intervals (CI). Results: Thirteen studies (11 RCTs, 2 cohorts; 1503 MIS, 1401 MM) were included. MIS significantly improved functional outcomes (Risk Ratio, RR 1.18, 95% CI 1.01 to 1.38), driven mainly by studies including both deep and lobar hematomas, whereas deep-only studies showed inconsistent effects. The benefit was largely attributable to stereotactic aspiration with local thrombolytics (RR 1.23, 95% CI 1.07 to 1.41), while other MIS techniques showed no significant advantage. Early intervention (<24 h) demonstrated better outcomes (RR 1.16, 95% CI 1.07-1.26). Thirty-day mortality was lower with MIS (RR 0.63, 95% CI 0.49-0.80). No significant differences were observed for ICU stay (Mean Difference, MD -0.15 days, 95% CI -1.34 to 1.05) or rebleeding (RR 1.57, 95% CI 0.84-2.97). Severe adverse events were lower in MIS (RR 0.80, 95% CI 0.71-0.89). Conclusions: MIS may reduce mortality and improve functional outcomes in supratentorial ICH, particularly using stereotactic aspiration with thrombolytics. The benefit in deep hematomas remains uncertain. Early intervention and careful patient selection are essential. Further high-quality RCTs are warranted.
Insights
Minimally invasive surgery (MIS) improves functional outcomes and reduces mortality in supratentorial intracerebral hemorrhage (ICH) compared to medical management. Stereotactic aspiration with thrombolytics shows the most benefit, especially with early intervention.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Intracerebral hemorrhage (ICH) management often involves medical management (MM) or surgery.
- Minimally invasive surgery (MIS) is a less invasive alternative to MM for ICH.
- The comparative effectiveness of MIS versus MM for supratentorial ICH requires further clarification.
Purpose of the Study:
- To compare the effectiveness of minimally invasive surgery (MIS) versus medical management (MM) for supratentorial spontaneous intracerebral hemorrhage (ICH).
- To evaluate functional recovery, mortality, adverse events, rebleeding rates, and ICU stay.
- To identify specific MIS techniques and intervention timings associated with better outcomes.
Main Methods:
- Systematic literature search of PubMed, Web of Science, Scopus, and Cochrane Library.
- Inclusion of randomized controlled trials (RCTs) and prospective matched cohort studies comparing MIS with MM in supratentorial spontaneous ICH.
- Meta-analysis using RevMan 5.4 software with 95% confidence intervals (CI) for primary (functional recovery, mortality) and secondary outcomes (adverse events, rebleeding, ICU stay).
Main Results:
- Thirteen studies (11 RCTs, 2 cohorts) involving 1503 MIS and 1401 MM patients were analyzed.
- MIS significantly improved functional outcomes (RR 1.18, 95% CI 1.01-1.38) and reduced 30-day mortality (RR 0.63, 95% CI 0.49-0.80).
- Stereotactic aspiration with thrombolytics and early intervention (<24h) were associated with better outcomes; severe adverse events were lower with MIS (RR 0.80, 95% CI 0.71-0.89).
Conclusions:
- Minimally invasive surgery (MIS) may offer significant benefits in reducing mortality and improving functional outcomes for supratentorial intracerebral hemorrhage (ICH).
- Stereotactic aspiration combined with thrombolytics appears particularly effective, especially when initiated early.
- Further high-quality RCTs are needed to confirm benefits in deep hematomas and optimize patient selection for MIS.
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