Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in context
Summary: Background: Surgical interventions for spontaneous supratentorial intracerebral haemorrhage (ICH) include conventional craniotomy (CC), decompressive craniectomy (DC), and minimally invasive surgery (MIS), with the latter encompassing endoscopic surgery (ES) and minimally invasive puncture...
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Elsevier
2025-01-01
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| author | Jiayidaer Huan Minghong Yao Yu Ma Fan Mei Yanmei Liu Lu Ma Xiaochao Luo Jiali Liu Jianguo Xu Chao You Hunong Xiang Kang Zou Xiao Liang Xin Hu Ling Li Xin Sun |
| author_facet | Jiayidaer Huan Minghong Yao Yu Ma Fan Mei Yanmei Liu Lu Ma Xiaochao Luo Jiali Liu Jianguo Xu Chao You Hunong Xiang Kang Zou Xiao Liang Xin Hu Ling Li Xin Sun |
| author_sort | Jiayidaer Huan |
| collection | DOAJ |
| description | Summary: Background: Surgical interventions for spontaneous supratentorial intracerebral haemorrhage (ICH) include conventional craniotomy (CC), decompressive craniectomy (DC), and minimally invasive surgery (MIS), with the latter encompassing endoscopic surgery (ES) and minimally invasive puncture surgery (MIPS). However, the superiority of surgery over conservative medical treatment (CMT) and the comparative benefits of different surgical procedures remain unclear. We aimed to evaluate the efficacy and safety of various surgical interventions for treating ICH. Methods: In this systematic review and network meta-analysis, we searched PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from inception to June 16, 2024. Eligible studies were randomised controlled trials (RCTs) comparing surgery (i.e., CC, ES, MIPS, or DC) with CMT or comparing different types of surgeries in patients with spontaneous supratentorial ICH. Paired reviewers independently screened citations, assessed the risk of bias of included trials, and extracted data. Primary outcomes were good functional outcome and mortality at 6 months. Secondary outcomes were good functional outcome and mortality at different follow-up times, complications (rebleeding, brain infection, pulmonary infection), and hematoma evacuation rate. The frequentist pairwise and network meta-analysis (NMA) were performed. The GRADE approach was used to evaluate the certainty of evidence. This study is registered with PROSPERO, CRD42024518961. Findings: Of the 8573 total records identified by our searches, 31 studies (6448 patients) were eligible for the systematic review and network analysis. Compared with CMT, moderate certainty evidence showed that surgery improved good functional outcome (risk ratio [RR] 1.31, 95% CI 1.13–1.52; risk difference [RD] 9.1%, 95% CI 3.8 to 15.3; I2 = 36%) and reduced mortality (RR 0.82, 95% CI 0.71–0.95; RD −5.1%, 95% CI −8.2 to −1.4; I2 = 14%). Moderate certainty evidence from NMA suggested that compared with CMT, both ES (RR 1.51, 95% CI 1.18–1.93; RD 9.4%, 95% CI 3.3–17.1) and MIPS (RR 1.48, 95% CI 1.24–1.76; RD 15.7%, 95% CI 7.9–24.9) improved good functional outcome at 6 months, and both ES (RR 0.66, 95% CI 0.52–0.85; RD −17.0%, 95% CI −24.0 to −7.5) and CC (RR 0.75, 95% CI 0.60–0.94; RD −6.3%, 95% CI −10.1 to −1.5) reduced mortality at 6 months, whereas MIPS and DC showed a trend, although not statistically significant, towards a reduction in mortality. ES and MIPS also reduced pulmonary infection risk (ES RR 0.39, 95% CI 0.23–0.69; MIPS RR 0.35, 95% CI 0.20–0.60; RD −5.3%, 95% CI −6.6 to −3.3). ES showed higher hematoma evacuation than CC (MD: 7.03, 95% CI: 3.42–10.65; I2 = 94%). No difference in rebleeding or brain infection was found between CC and MIS. Interpretation: Current moderate certainty evidence suggested that surgical intervention of spontaneous supratentorial ICH, may be associated with improved functional outcomes and a reduced risk of death at 6 months. The advantages of surgical haematoma removal are particularly pronounced when MIS including ES and MIPS are employed. ES could improve functional outcomes, reduce the risk of mortality and pulmonary infection, and have a high hematoma evacuation rate, suggesting that it might be an optimal surgical treatment. Funding: National Natural Science Foundation of China, National Science Fund for Distinguished Young Scholars, Fundamental Research Funds for the Central Public Welfare Research Institutes, and 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University. |
| format | Article |
| id | doaj-art-f3c1437424ed4b48a1dd4fd155465b9a |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | EClinicalMedicine |
| spelling | doaj-art-f3c1437424ed4b48a1dd4fd155465b9a2025-01-22T05:43:27ZengElsevierEClinicalMedicine2589-53702025-01-0179102999Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in contextJiayidaer Huan0Minghong Yao1Yu Ma2Fan Mei3Yanmei Liu4Lu Ma5Xiaochao Luo6Jiali Liu7Jianguo Xu8Chao You9Hunong Xiang10Kang Zou11Xiao Liang12Xin Hu13Ling Li14Xin Sun15Department of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China; Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Encephalopathy, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, ChinaDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; Corresponding author. Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan, China.Department of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Corresponding author. Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan, China.Department of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China; Sichuan Centre of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China; Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Corresponding author. Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan, China.Summary: Background: Surgical interventions for spontaneous supratentorial intracerebral haemorrhage (ICH) include conventional craniotomy (CC), decompressive craniectomy (DC), and minimally invasive surgery (MIS), with the latter encompassing endoscopic surgery (ES) and minimally invasive puncture surgery (MIPS). However, the superiority of surgery over conservative medical treatment (CMT) and the comparative benefits of different surgical procedures remain unclear. We aimed to evaluate the efficacy and safety of various surgical interventions for treating ICH. Methods: In this systematic review and network meta-analysis, we searched PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from inception to June 16, 2024. Eligible studies were randomised controlled trials (RCTs) comparing surgery (i.e., CC, ES, MIPS, or DC) with CMT or comparing different types of surgeries in patients with spontaneous supratentorial ICH. Paired reviewers independently screened citations, assessed the risk of bias of included trials, and extracted data. Primary outcomes were good functional outcome and mortality at 6 months. Secondary outcomes were good functional outcome and mortality at different follow-up times, complications (rebleeding, brain infection, pulmonary infection), and hematoma evacuation rate. The frequentist pairwise and network meta-analysis (NMA) were performed. The GRADE approach was used to evaluate the certainty of evidence. This study is registered with PROSPERO, CRD42024518961. Findings: Of the 8573 total records identified by our searches, 31 studies (6448 patients) were eligible for the systematic review and network analysis. Compared with CMT, moderate certainty evidence showed that surgery improved good functional outcome (risk ratio [RR] 1.31, 95% CI 1.13–1.52; risk difference [RD] 9.1%, 95% CI 3.8 to 15.3; I2 = 36%) and reduced mortality (RR 0.82, 95% CI 0.71–0.95; RD −5.1%, 95% CI −8.2 to −1.4; I2 = 14%). Moderate certainty evidence from NMA suggested that compared with CMT, both ES (RR 1.51, 95% CI 1.18–1.93; RD 9.4%, 95% CI 3.3–17.1) and MIPS (RR 1.48, 95% CI 1.24–1.76; RD 15.7%, 95% CI 7.9–24.9) improved good functional outcome at 6 months, and both ES (RR 0.66, 95% CI 0.52–0.85; RD −17.0%, 95% CI −24.0 to −7.5) and CC (RR 0.75, 95% CI 0.60–0.94; RD −6.3%, 95% CI −10.1 to −1.5) reduced mortality at 6 months, whereas MIPS and DC showed a trend, although not statistically significant, towards a reduction in mortality. ES and MIPS also reduced pulmonary infection risk (ES RR 0.39, 95% CI 0.23–0.69; MIPS RR 0.35, 95% CI 0.20–0.60; RD −5.3%, 95% CI −6.6 to −3.3). ES showed higher hematoma evacuation than CC (MD: 7.03, 95% CI: 3.42–10.65; I2 = 94%). No difference in rebleeding or brain infection was found between CC and MIS. Interpretation: Current moderate certainty evidence suggested that surgical intervention of spontaneous supratentorial ICH, may be associated with improved functional outcomes and a reduced risk of death at 6 months. The advantages of surgical haematoma removal are particularly pronounced when MIS including ES and MIPS are employed. ES could improve functional outcomes, reduce the risk of mortality and pulmonary infection, and have a high hematoma evacuation rate, suggesting that it might be an optimal surgical treatment. Funding: National Natural Science Foundation of China, National Science Fund for Distinguished Young Scholars, Fundamental Research Funds for the Central Public Welfare Research Institutes, and 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University.http://www.sciencedirect.com/science/article/pii/S2589537024005789Intracerebral haemorrhageSurgical interventionSystematic reviewNetwork meta-analysis |
| spellingShingle | Jiayidaer Huan Minghong Yao Yu Ma Fan Mei Yanmei Liu Lu Ma Xiaochao Luo Jiali Liu Jianguo Xu Chao You Hunong Xiang Kang Zou Xiao Liang Xin Hu Ling Li Xin Sun Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in context EClinicalMedicine Intracerebral haemorrhage Surgical intervention Systematic review Network meta-analysis |
| title | Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in context |
| title_full | Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in context |
| title_fullStr | Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in context |
| title_full_unstemmed | Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in context |
| title_short | Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysisResearch in context |
| title_sort | surgical interventions for spontaneous supratentorial intracerebral haemorrhage a systematic review and network meta analysisresearch in context |
| topic | Intracerebral haemorrhage Surgical intervention Systematic review Network meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024005789 |
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