Early Removal of Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis
Rubia Bezerra Muniz de Sousa1, Lívia Fabricia Francisco de Lima1, Catarina Araujo Lima1, Maria Luiza Costa de Melo Pessoa1, Ana Luiza Carvalho2, Maria Villalba3, Manuela Queiroz2, Luana Carvalho4, Luca Augusto5, Artur Almeida6, Samuel Pinheiro7, Luis Rodrigues8
1University of Pernambuco, 2Federal University of Amazonas, 3Central University of Ecuador, 4State University of Amazonas, 5University of Taubaté, 6Federal University of Mato Grosso, 7Federal University of Bahia, 8Federal University of Pará
Objective:
The preferred approach for treating spontaneous intracerebral hemorrhage remains unclear, either early surgery or a conservative treatment. Hence, we sought to compare these treatment methods in this population.
Background:
The aim is to analyze the prognosis of patients with superficial lobar intracerebral hemorrhage and spontaneous supratentorial intracerebral hemorrhage when undergoing early surgery or conservative treatment.
Design/Methods:
Medline, Cochrane, and Embase databases were systematically searched until 25 September 2024 for Randomized Controlled Trials comparing early surgery and conservative treatment to remove hematoma caused by spontaneous supratentorial intracerebral hemorrhages. Data were examined using the Mantel-Haenszel method and 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. RStudio, version 4.3.2, was used for statistical analysis.
Results:
A total of 3 randomized controlled trials and 1934 patients were included, of whom 960 (49,6%) underwent early surgery for the removal of the hematoma caused by spontaneous supratentorial intracerebral hemorrhage and 974 (50,4%) received the conservative treatment. Compared with the conservative treatment group, the early surgery group achieved better rates of favorable prognosis based on the modified Rankin scale at 180 days (40% vs 35%; OR 1.25; 95%CI 1.03-1.51; P= 0.024620; I²= 0%). Mortality (27% vs 32%; OR 0.66; 95%CI 0.39-1.12; P= 0.123310; I²= 78%) and favorable or unfavorable prognosis based on the Extended Glasgow Outcome Scale (GOSE) at 180 days (32% vs 29%; OR 1.15; 95%CI 0.92-1.43; P= 0.221678; I²= 0%) and (68% vs 71%; RR 0.96; 95%CI 0.91-1.03; P= 0.270196; I²= 0%), respectively, did not reach a statistically significant difference between groups.
Conclusions:
In this meta-analysis, consistent results suggest that early surgery is associated with better rates of favorable prognosis, based on the modified Rankin scale at 180 days, than initial conservative treatment in patients with supratentorial intracerebral hemorrhage.
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