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Meta-Analysis
. 2014 Sep 19;9(9):e107614.
doi: 10.1371/journal.pone.0107614. eCollection 2014.

Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials

Jia-Wei Wang  1 , Jin-Ping Li  1 , Ying-Lun Song  1 , Ke Tan  1 , Yu Wang  1 , Tao Li  1 , Peng Guo  1 , Xiong Li  1 , Yan Wang  1 , Qi-Huang Zhao  1
Affiliations
Meta-Analysis

Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials

Jia-Wei Wang et al. PLoS One. .

Abstract

Background: A wealth of evidence based on the randomized controlled trials (RCTs) has indicated that surgery may be a better choice in the management of primary intracerebral hemorrhage (ICH) compared to conservative treatment. However, there is considerable controversy over selecting appropriate surgical procedures for ICH. Thus, this meta-analysis was performed to assess the effects of stereotactic aspiration compared to craniotomy in patients with ICH.

Methods: According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials. Other sources such as the internet-based clinical trial registries, relevant journals and the lists of references were also searched. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included death or dependence, total risk of complication, and the risk of rebleeding, gastrointestinal hemorrhage and systematic infection.

Results: Four RCTs with 2996 participants were included. The quality of the included trials was acceptable. Stereotactic aspiration significantly decreased the odds of death or dependence at the final follow-up (odds ratio (OR): 0.80, 95% confidence interval (CI): 0.69-0.93; P = 0.004) and the risk of intracerebral rebleeding (OR: 0.44, 95% CI: 0.26-0.74; P = 0.002) compared to craniotomy with no significant heterogeneity among the study results.

Conclusions: The present meta-analysis provides evidence that the stereotactic aspiration may be associated with a reduction in the odds of being dead or dependent in primary ICH, which should be interpreted with caution. Further trials are needed to identify those patients most likely to benefit from the stereotactic aspiration.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of study inclusion in the present meta-analysis.
Figure 2
Figure 2. Death or dependence between the groups.
A: stereotactic aspiration versus craniotomy; B: stereotactic aspiration versus conventional open craniotomy; C: stereotactic aspiration versus key-hole craniotomy. M-H: Mantel-Haenszel.
Figure 3
Figure 3. Death between the groups.
A: stereotactic aspiration versus craniotomy; B: stereotactic aspiration versus conventional open craniotomy; C: stereotactic aspiration versus key-hole craniotomy. M-H: Mantel-Haenszel.
Figure 4
Figure 4. Total risk of complication between the groups.
A: stereotactic aspiration versus craniotomy; B: stereotactic aspiration versus conventional open craniotomy; C: stereotactic aspiration versus key-hole craniotomy. M-H: Mantel-Haenszel.
Figure 5
Figure 5. Risk of rebleeding between the groups based on the type of craniotomy.
M-H: Mantel-Haenszel.
Figure 6
Figure 6. Risk of gastrointestinal hemorrhage between the groups based on the type of craniotomy.
M-H: Mantel-Haenszel.
Figure 7
Figure 7. Risk of systematic infection between the groups based on the type of craniotomy.
M-H: Mantel-Haenszel.
See this image and copyright information in PMC

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