Abstract
BackgroundRecently, minimal invasive surgery (MIS) has been applied as a common therapeutic approach for treatment of hypertensive intracerebral hemorrhage (HICH). However, the efficacy and safety of MIS is still controversial compared with conservative medical treatment or conventional craniotomy. This meta-analysis aimed to systematically assess the safety and efficacy of MIS compared with conservative method and craniotomy in treating HICH patients.MethodsPubMed, Embase, Web of Science, and Cochrane Controlled Trials Register were used to identify relevant studies on MIS treatment of HICH up to November 2017. This study evaluated Glasgow Outcome Scale (GOS) score, Activities of Daily Living (ADL) score, pulmonary infection rate, mortality rate, and rebleeding rate for patients who underwent MIS, or conservative method, or craniotomy. Subgroup analyses were performed to compare randomization versus non-randomization and large hematoma versus small or mild hematoma. Begg’s test and Egger’s test were used to determine the potential presence of publication bias.ResultsSixteen studies consisting of 1912 patients were included in this study to compare the efficacy and safety of MIS to conservative method or craniotomy. MIS contributed to a significant improvement on the prognosis of the patients comparing with conservative group or craniotomy group. Patients undergoing MIS had a lower mortality rate when compared to those receiving conservative method. Also, MIS led to a notable reduction of rebleeding rate and an effective improvement of the patient’s quality of life by contrast with craniotomy. No obvious difference was found in terms of the pulmonary infection rate among the comparisons of three treatment methods. Randomization is not the potential source of heterogeneity, but hematoma volume may be a risk factor for post-operative mortality rate. No statistical evidence of publication bias among studies was found under most of comparison models.ConclusionThis meta-analysis suggests that minimal invasive surgery is an efficient and safe method for the treatment of hypertensive intracerebral hemorrhage, which is associated with a low mortality rate and rebleeding rate, as well as a significant improvement of the prognosis and the quality life of patients when compared with conservative medical treatment or craniotomy.
Highlights
Minimal invasive surgery (MIS) has been applied as a common therapeutic approach for treatment of hypertensive intracerebral hemorrhage (HICH)
Hypertensive intracerebral hemorrhage (HICH) has been reported to account for 50–70% of all spontaneous intracranial hemorrhage (ICH), its morbidity and mortality both occupy the top among all types of strokes, more than 30% survivors suffer from varying degrees of disability [3, 4]
Nakano’s report [24]. 388 patients in 5 studies were treated with minimal invasive surgery (MIS) vs. conservative method [17, 19, 20, 23, 25], whereas 1085 patients in 8 studies were treated with MIS vs. craniotomy [5, 9, 16, 18, 21, 22, 27, 29], and 439 patients in 3 studies were treated with MIS vs. craniotomy or conservative method [24, 26, 28]
Summary
Minimal invasive surgery (MIS) has been applied as a common therapeutic approach for treatment of hypertensive intracerebral hemorrhage (HICH). The efficacy and safety of MIS is still controversial compared with conservative medical treatment or conventional craniotomy This meta-analysis aimed to systematically assess the safety and efficacy of MIS compared with conservative method and craniotomy in treating HICH patients. HICH has been reported to account for 50–70% of all spontaneous intracranial hemorrhage (ICH), its morbidity and mortality both occupy the top among all types of strokes, more than 30% survivors suffer from varying degrees of disability [3, 4]. A study reported that the HICH patients with a hematoma volume > 50 ml are of a greater probability of mortality and disability [6]. Based on the risks and harmfulness of HICH, it is urgently necessary to seek out an effective therapeutic strategy for curing the patients with hypertensive cerebral hemorrhage (HCH)
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