Meta-analysis of randomized studies of surgery for supratentorial intracerebral hemorrhage

Objective: The efficacy of surgical treatments on supratentorial intracerebral hemorrhage (STICH) is not conclusive although many studies have been performed. Relevant factors, such as the injury inflicted to the brain by different kinds of surgery, degrees of severity, and locations of intracerebral hemorrhage (ICH), should be taken into consideration for a better appraisal of the efficacy of surgery on STICH. Methods: Randomized controlled trials to evaluate the efficacy of surgery on STICH were included for this meta-analysis. The appraised primary outcome was death, and the secondary outcome was death or dependence. Results: Eighteen studies with 3616 patients were included in this meta-analysis. Surgery and minimal invasive surgery (MIS) showed a significant reduction in mortality as the primary outcome, and mortality or dependence as the secondary outcome, for all the intracerebral hemorrhage (ICH) patients and of the subgroup of deep-located ICH patients. MIS also showed a significant reduction both in mortality and dependence of the subgroup of putaminal ICH patients. In contrast, craniotomy showed no significantly better outcome than medical treatment. However, we found the mortality rate of the medical treatment group in the studies of craniotomy and MIS was different: 39% versus 20% for all cases of ICH, 50% versus 16% for putaminal ICH, and 51% versus 15% for deep ICH. Conclusion: In terms of mortality and dependence, MIS had significantly better results than medical treatment for STICH, deep ICH, and putaminal ICH. In the present review, craniotomy showed no significantly better outcome than medical treatment. Copyright (C) 2014, Taiwan Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.