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Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage: a Systematic Review and Meta-Analysis
Sun S, Li Y, Zhang H, Gao H, Zhou X, Xu Y, Yan K, Wang X
World neurosurgery. 2019
Abstract
BACKGROUND No consensus on the superiority between neuroendoscopy (NE) and craniotomy (CT) for the treatment of supratentorial hypertensive intracerebral hemorrhage (HICH) has been achieved. The purpose of this study is to analyze the efficacy and safety of NE versus CT for supratentorial HICH. METHOD A systematic search of English databases (PubMed, Embase, the Cochrane Library, Web of Science) was performed to identify related studies published from September 1994 to June 2019. The Newcastle-Ottawa Scale (NOS) and the Cochrane Reviewer's Handbook 5.0.0 were separately used to evaluate the quality of the included observational studies (OSs) and randomized controlled trials (RCTs). RevMan 5.3 software was adopted to conduct the meta-analysis. The outcome measures included the primary and secondary outcomes. Subgroup analysis was performed to explore the impact of year of publication, initial Glasgow Coma Scale (GCS), age, time to surgery, hematoma volume and surgical methods on the outcome measures. RESULTS Fifteen studies (three RCTs and twelve OSs), containing 1859 supratentorial HICH patients, were included in this meta-analysis. The pooled results showed that NE could increase the good functional outcome (GFO) (P <0.0003) and hematoma evacuation rate (P = 0.0007); reduce the mortality (P <0.00001), blood loss (P = 0.004), operation time (P <0.00001), hospital stays (P = 0.006), and ICU stays (P <0.0001) when compared with CT. In addition, NE could also have a positive effect on preventing postoperative infection (P <0.00001) and total complications (P <0.00001). However, in the aspect of postoperative rebleeding incidence (P = 0.12), no obvious difference was found between the two group. Publication bias was low regarding GFO, mortality, and hematoma evacuation rate. Subgroup analysis suggested year of publication, initial GCS, age, hematoma volume and surgical methods did not affect the hematoma evacuation rate significantly. The difference in mortality was not statistically significant in the subgroup of hematoma volume < 50ml (P = 0.44) and initial GCS > 8 (P = 0.09). In addition, the data suggested that time to surgery and surgical methods might be the important factors affecting the GFO and mortality. CONCLUSION NE might be a safer and more effective surgical method than CT in the treatment of patients with supratentorial HICH. However, due to the existence of some limitations, the safety and validity of NE was weakened. More high-quality trials should be included to verify our conclusion.