Abstract WMP73: Minimally Invasive Surgery for Intracerebral Hemorrhage: Meta-Analysis of High Quality RCTs

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Background: Intracerebral hemorrhage (ICH) represents a devastating clinical entity with disproportionately higher rates of mortality and functional disability compared to ischemic stroke. As large trials of craniotomy in ICH failed to prove functional benefits, minimally invasive surgery (MIS) represents a potential frontier of ICH management with evidence of functional and mortality improvements. We aimed to provide level A evidence of MIS role in ICH management. Methods: Independent authors searched four electronic databases (Medline, Embase, Web of Science, and CENTRAL) and assessed the methodological quality of included studies using the Cochrane risk of bias tool (RoB2). Only high-quality (low risk of bias in all RoB2 domains) randomized clinical trial (RCTs) were included. We pooled odd ratios (ORs) with corresponding 95% confidence intervals (CIs) using random-effects model. Results: Six high-quality RCTs met our inclusion criteria. Among 1551 ICH patients, 810 were allocated to the MIS group and 741 to non-MIS. MIS was associated with significantly lower odds of mortality or disability at 90-days (OR, 0.71 [95% CI, 0.52-0.97]; p = 0.03) and lower odds of 90-days mortality (OR, 0.71 [95% CI, 0.49-1.03]; p = 0.07). Rates of functional independence and favorable functional outcomes was higher in MIS treated individuals (OR, 1.81 [95% CI, 0.78-1.79]; p = 0.43) and (OR, 1.31 [95% CI, 0.96-1.78]; p = 0.09), respectfully. Conclusions: This meta-analysis provides level A evidence that supports the current notion of mortality and functional improvement in ICH individuals treated with MIS. Further RCTs are warranted to validate the generalizability of these results.