Minimally invasive surgery versus craniotomy for intracerebral hemorrhage: An updated systematic review and meta-analysis of randomized clinical trials

Abstract

Intracerebral hemorrhage (ICH) is a severe stroke with high mortality and incapacity rates, treatable by minimally invasive surgery (MIS) or craniotomy. However, the optimal surgical approach remains unclear. This study compares the outcomes of MIS and craniotomy for ICH patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. PubMed, Embase, Cochrane, and Web of Science were searched for randomized controlled trials (RCTs) comparing MIS and craniotomy for ICH patients. The Mantel-Haenszel and inverse variance tests were used for binary and continuous outcomes, respectively. We assessed favorable functional outcomes, intraoperative blood loss, operation time, rebleeding and mortality. R 4.4.2 was used for all statistical analyses. The risk of bias was evaluated with the Cochrane tool RoB 2. Of 1,247 potential articles, 12 RCTs met the eligibility criteria, comprising a total of 2,454 patients, with 1,368 (55.8 %) and 1,086 (44.2 %) patients in the MIS and craniotomy groups, respectively. MIS was superior to craniotomy in improving functional outcome (RR: 1.41; 95 % CI 1.26, 1.58; p < 0.001), and both neuroendoscopy and minimally invasive puncture surgery subgroups also showed a benefit over craniotomy. Intraoperative blood loss was reduced with neuroendoscopy (MD: −158.50; 95 % CI −257.57, −59.44; p = 0.002). MIS also resulted in shorter operation time (MD: −109.51; 95 % CI −144.31, −74.71; p < 0.001). Rebleeding and mortality rates did not reach statistical significance. MIS was associated with better functional outcomes, lower intraoperative blood loss, and shorter operative time compared with craniotomy.