Minimally invasive surgical approaches may reduce mortality and improve functional recovery in patients with spontaneous intracerebral hemorrhage, according to a new systematic review and network meta-analysis published in Stroke & Vascular Neurology; although most comparisons were graded as low or very low certainty.
Intracerebral hemorrhage (ICH) is a life-threatening type of stroke associated with high mortality and long-term disability. Despite advances in standard medical care, outcomes remain poor. Surgical evacuation of the hematoma has long been considered a potential life-saving intervention, the researchers wrote, but questions remain about which techniques offer the greatest benefit.
“Intracerebral haemorrhage (ICH) is a critical condition that leads to significant mortality or profound disability,” the authors said.
The investigators analyzed 26 randomized controlled trials involving 4,892 adults with spontaneous supratentorial ICH. Using a frequentist network meta-analysis, they compared standard medical care with several surgical strategies, including conventional craniotomy, decompressive craniectomy, endoscopic surgery, and minimally invasive puncture surgery.
Compared with standard medical care, endoscopic surgery was associated with a 34% relative reduction in mortality, and minimally invasive puncture surgery was associated with a 23% relative reduction. Both minimally invasive approaches were also linked to improved functional independence. Endoscopic surgery was associated with a 62% increased likelihood of functional independence, while minimally invasive puncture surgery showed a 53% increase.
In contrast, conventional craniotomy did not demonstrate statistically significant improvements in mortality or functional outcomes compared with medical therapy alone.
Subgroup analyses suggested that earlier intervention was associated with greater gains in functional independence, particularly for minimally invasive techniques.
“This systematic review and network meta-analysis found that endoscopic surgery and minimally invasive puncture surgery were associated with lower mortality and better functional outcomes compared with other interventions,” the authors said, while also cautioning that the certainty of evidence was limited due to heterogeneity in patient populations and treatment protocols.
Most comparisons were graded as low or very low certainty because of concerns about study bias, variations in how functional independence was defined, and differences in surgical methods and timing. The researchers emphasized the need for large, rigorously designed randomized trials with standardized protocols to clarify which patients are most likely to benefit and to confirm the potential advantages of minimally invasive surgery.
The authors did not declare any competing interests.
Source: Stroke & Vascular Neurology
