Zhiwei Xia1, Xinlong Wu2, Jing Li1, Zhixiong Liu3, Fenghua Chen3, Longbo Zhang3, Hongfu Zhang4, Xin Wan5, Quan Cheng6. 1. Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China. 2. Department of Neurosurgery, XinJiang Karamay DuShanZi People's Hospital, Karamay, Xinjiang, China. 3. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China. 4. Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, China. 5. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China. Electronic address: wanxin70108@sina.com. 6. Department of Neurosurgery, XinJiang Karamay DuShanZi People's Hospital, Karamay, Xinjiang, China. Electronic address: chengquan@csu.edu.cn.
Abstract
BACKGROUND: Outcomes of minimally invasive surgery (MIS) versus conventional craniotomy (CC) for patients with spontaneous supratentorial intracerebral hemorrhage (SICH) have not been compared previously. We reviewed the current evidence regarding the safety and efficacy of MIS compared with CC in patients with SICH. METHODS: We conducted a meta-analysis of studies comparing MIS and CC in patients with computed tomography-confirmed SICH published between January 2000 and April 2018 in MEDLINE, Embase, and the Cochrane Controlled Trials Register 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 9 prospective controlled studies (non-RCTs), involving a total of 2466 patients, met our inclusion criteria. There was a statistically significant difference in mortality rate between MIS and CC (OR, 0.76; 95% confidence interval [CI], 0.60-0.97). MIS was associated with a lower rate of rebleeding (OR, 0.42; 95% CI, 0.28-0.64) and a higher rate 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 optimize treatment strategies in SICH.
BACKGROUND: Outcomes of minimally invasive surgery (MIS) versus conventional craniotomy (CC) for patients with spontaneous supratentorial intracerebral hemorrhage (SICH) have not been compared previously. We reviewed the current evidence regarding the safety and efficacy of MIS compared with CC in patients with SICH. METHODS: We conducted a meta-analysis of studies comparing MIS and CC in patients with computed tomography-confirmed SICH published between January 2000 and April 2018 in MEDLINE, Embase, and the Cochrane Controlled Trials Register 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 9 prospective controlled studies (non-RCTs), involving a total of 2466 patients, met our inclusion criteria. There was a statistically significant difference in mortality rate between MIS and CC (OR, 0.76; 95% confidence interval [CI], 0.60-0.97). MIS was associated with a lower rate of rebleeding (OR, 0.42; 95% CI, 0.28-0.64) and a higher rate 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 optimize treatment strategies in SICH.
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