Stereotactic-Guided Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage: Systematic Review and Meta-Analysis

Abstract

Background: Spontaneous intracerebral hemorrhage (SICH) has a high morbidity and mortality and places a huge significant economic burden on health care and social services. The role of surgery is still controversial as evidenced by wide variation internationally in management of SICH. Traditional surgery for SICH involved open craniotomy with hematoma evacuation. Using available evidence, this article assesses the efficacy of stereotactic-guided evacuation compared with medical treatment.

Methods: A systematic review was performed comparing stereotactic-guided evacuation of SICH with conservative medical management. Eligible studies were identified using a text word search of an electronic journal database for randomized controlled trials. Extracted data outcomes were subjected to meta-analysis with a forest plot. Quality was assessed using Cochrane risk of bias analysis tools.

Results: There were 5 studies with 740 patients. There was a nonsignificant reduction in odds ratio (OR) for death at the end of the follow-up period (OR = 0.74, 95% confidence interval = 0.45-1.21) with no significant heterogeneity. Nonsignificant benefits were observed for dependent survival (OR = 2.14, 95% confidence interval = 0.31-0.58). In the subgroup analysis, stereotactic evacuation showed improved outcomes in patients with hematoma volume <50 mL. In this review, the effectiveness of stereotactic evacuation plus subsequent thrombolysis was insignificant (OR = 1.34, 95% confidence interval = 0.57-3.12).

Conclusions: The outcome of patients who had stereotactic-guided evacuation of SICH was not better compared with patients who received medical treatment; however, there was a trend toward better quality of survival and chance of survival in the stereotactic-guided evacuation group. This study identified areas for further research.

Keywords: Intracerebral hemorrhage; Medical management; Stereotactic-guided evacuation.