Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage A meta-analysis

Background: In recent years, neuroendoscopy has been used as a method for treating intracerebral hemorrhages (ICHs). However, the efficacy and safety of neuroendoscopic surgery is still controversial compared with that of craniotomy. Our aim was to compare the outcomes of neuroendoscopic surgery and craniotomy in patients with supratentorial hypertensive ICH using a metaanalysis. Methods: We searched on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of eligible studies was evaluated and the related data were extracted by 2 reviewers independently. This study assessed clinical outcomes, evacuation rates, complications, operation time, and hospital stay for patients who underwent neuroendoscopic surgery (NE group) or craniotomy (craniotomy group). Results: Meta-analysis included 1327 subjects from verified studies of acceptable quality. There was no significant heterogeneity between the included studies based on clinical outcomes. Compared with craniotomy, neuroendoscopic surgery significantly improved clinical outcomes in both randomized controlled studies (RCTs) group (relative risk: 0.62; 95% confidence interval [CI], 0.47-0.81, P<.001) and non-RCTs group (relative risk: 0.84; 95% CI: 0.75-0.95, P=.005); decreased the rate of death (relative risk: 0.53; 95% CI, 0.37-0.76, P<.001) in non-RCTs group but not in RCTs group (relative risk: 0.58; 95% CI, 0.26-1.29, P=.18); increased evacuation rates in non-RCTs group (standard mean differences: 0.75; 95% CI, 0.24-1.26, P=.004) and had a tendency of higher evacuation rates in RCTs group (standard mean differences: 1.34; 95% CI, 0.01-2.68, P=.05); reduced the total risk of complications in non-RCTs group (relative risk: 0.45; 95% CI, 0.25-0.83, P=.01) and RCTs group (relative risk: 0.37; 95% CI, 0.28-0.49, P<.001); reduced the operation time in non-RCTs group (standard mean differences: 3.26; 95% CI: 1.20-5.33, P<.001) and RCTs group (standard mean differences: 4.37; 95% CI: 3.32-5.41, P<.001). Conclusions: Our results suggested that the NE group showed better clinical outcomes than the craniotomy group for patients with supratentorial hypertensive ICH. Moreover, the patients who underwent neuroendoscopy had a higher evacuation rate, lower risk of complications, and shorter operation time compared with those that underwent a craniotomy. Abbreviations: ADL = activities of daily living, BI = Barthel Index, CI = confidence interval, GCS = Glass coma scale, GOS = Glasgow Outcome Scale, HICH = hypertensive intracerebral hemorrhage, mRS = modified Rankin Scale, NE = neuroendoscopy, RCTs = randomized controlled studies, RR = relative risk, SMD = standard mean differences.