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Minimally invasive surgery is superior to conventional craniotomy in patients with spontaneous supratentorial Intracerebral hemorrhage:a systematic review and meta-analysis
Xia Z, Wu X, Li J, Liu Z, Chen F, Zhang L, Zhang H, Wan X, Cheng Q
World Neurosurgery. 2018;115:266-273
Abstract
BACKGROUND Outcomes of minimally invasive surgery (MIS) versus conventional craniotomy (CC) for patients with spontaneous supratentorial intracerebral hemorrhage(SICH) have not been previously compared. We reviewed the current evidence regarding the safety and efficacy of MIS as compared with conventional craniotomy, in patients with SICH. METHODS We conducted a meta-analysis of studies that comparing MIS and CC in patients with computed tomography confirmed SICH, published from January 2000 to April 2018 in Medline, Embase, and Cochrane Controlled Trials Register (CCTR) based on PRISMA inclusion and exclusion criteria. Binary outcomes comparisons between MIS and CC were described using odds ratios (ORs). RESULTS Five randomized controlled trials (RCTs) and nine prospective controlled studies (non-RCTs) met the included criteria, involving 2466 patients. There was statistically significant difference in mortality rates between MIS and CC (OR, 0.76; 95% confidence interval [CI], 0.60-0.97). MIS associated with lower rates of complications in rebleeding (OR, 0.42; 95% CI, 0.28-0.64), and higher rates of good recovery compared with CC (OR, 2.27; 95% CI, 1.34-3.83). CONCLUSIONS Patients with SICH may benefit more from MIS than CC. Our study could help clinicians to optimize treatment strategies in SICH.