Minimally Invasive Surgery with Standard Care for Patients with Intracerebral Hemorrhage
Ha Le Duc Thien1, Nhan Nguyen2, Nghi Bao Tran2, Vinh Ho Quang Tri2, Vy Ngoc Dan Nguyen3, David Downes4
1University of Debrecen, Faculty of Medicine, 2Neurology, University of Debrecen, Faculty of Medicine, 3Nursing, The University of Melbourne, 4Rural Medicine, The University of New England, Armidale
Objective:
This study aimed to evaluate whether minimally invasive surgery (MIS), in addition to standard care, improves clinical outcomes in patients with intracerebral hemorrhage (ICH), specifically with respect to 30-day mortality and 180-day functional disability, compared with medical management (MM) alone.
Background:
Randomized controlled trials (RCTs) investigating MIS for ICH have yielded inconclusive results regarding short-term survival and long-term functional outcomes. A recently published RCT in 2025 further reported no significant differences between MIS and MM for these endpoints, highlighting the need for a comprehensive synthesis of existing evidence.
Design/Methods:
A systematic search of PubMed and the Cochrane Library was performed to identify RCTs evaluating MIS compared with MM in patients with ICH. Eligible studies were required to report at least one of the following outcomes: (1) 30-day all-cause mortality, (2) symptomatic or asymptomatic rebleeding within 72 hours, and (3) favorable functional outcome at 180 days, defined as a modified Rankin Scale (mRS) score ≤3. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical heterogeneity was assessed using the I² statistic.
Results:
Four RCTs comprising 1,138 patients were included (MIS: n = 613). MIS was associated with a lower 30-day mortality compared with MM (RR: 0.66; 95% CI: 0.48–0.92; p = 0.01). However, no difference was observed in mRS score ≤3 at 180 days between the two groups (RR: 1.12; 95% CI: 0.97–1.29; p = 0.13). Notably, MIS was associated with a higher risk of early rebleeding within 72 hours (RR: 3.47; 95% CI: 2.36–5.10; p < 0.00001). Across all outcomes, heterogeneity was minimal.
Conclusions:
MIS appears to confer a survival advantage at 30 days without significant improvement in long-term functional outcomes compared with MM, though it carries a substantially higher risk of early rebleeding. Further high-quality RCTs are warranted to confirm these findings for MIS in ICH.
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