Minimally Invasive Surgery is Superior to Conventional Craniotomy in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

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.