Decompressive craniectomy versus best medical treatment alone for spontaneous intracerebral hemorrhage: A systematic review and meta-analysis.

IF 8.7 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2025-08-05 DOI:10.1177/17474930251367367

Rafael Reis de Oliveira, Yasmin Picanço Silva, Yusuf-Zain Ansari, Mariana Letícia de Bastos Maximiano, Leonardo B O Brenner, Iago Nathan Simon Petry, Mariana Lee Han, Júlia Dos Santos Monteiro, Raphael Leal Dias da Silva, Laiana Neves Cordeiro Cavalcanti, Ocílio Ribeiro Gonçalves, Walter Fagundes

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引用次数: 0

Abstract

Background: While managing spontaneous intracerebral hemorrhage (sICH) has advanced, achieving favorable outcomes remains challenging. Recent studies suggest that decompressive craniectomy (DC) may offer benefits over conservative treatment, consisting of the best medical treatment (BMT) in certain sICH cases.

Aim: This study aims to compare DC to BMT alone for sICH regarding functional neurological outcomes, mortality, and length of hospitalization.

Methods: Randomized and observational studies were identified comparing surgery (DC) to conservative management alone for patients with sICH. The outcomes analyzed were modified Rankin Scale (mRS), mortality at 30 days, 90 days, and overall mortality, and length of hospital stay. The odds ratio (OR) and mean difference (MD) were calculated for binary and continuous outcomes.

Results: Our analysis included eight studies (n = 743), with 345 patients undergoing surgery and 398 undergoing conservative management. BMT alone was associated with a poor neurological function (mRS of 5-6) (OR = 0.44; 95% CI = 0.24-0.78; p-value = 0.005; I² = 39.8%), while the rate of good neurological function (mRS = 0-4) was superior in the surgical cohort (OR = 2.29; 95% CI = 1.28-4.10; p = 0.005; I² = 39.8%), despite the lack of statistical significance for mRS 0-2 (OR = 1.25; 95% CI = 0.47-3.33; p = 0.66; I² = 0%) and mRS 0-3 (OR = 1.43; 95% CI = 0.82-2.51; p = 0.21; I² = 0%). Conservative management was associated with higher mortality at 30 days (OR = 0.36; 95% CI = 0.19-0.66; p-value = 0.001; I² = 0%), at 90 days (OR = 0.35; 95% CI = 0.14-0.86; p = 0.022; I² = 68.7%), and at last follow-up (OR = 0.33; 95% CI = 0.21-0.52; p-value < 0.001; I² = 34.8%). Length of hospital stay was superior in the DC cohort, but without statistical significance (MD = 16.05; 95% CI = -3.24 to 35.34; p-value = 0.1; I² = 92.9%).

Conclusions: In patients with sICH, decompressive craniectomy shows potential for reducing mortality and improving neurological function compared to BMT alone. Further randomized studies, with improved methods, are needed to increase the quality of evidence.

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减压颅骨切除术与最佳药物治疗单独治疗自发性脑出血：系统回顾和荟萃分析。

背景：虽然自发性脑出血（siich）的治疗已经取得进展，但取得良好的结果仍然具有挑战性。最近的研究表明，在某些sICH病例中，减压颅骨切除术（DC）可能比保守治疗（包括最佳药物治疗（BMT））更有益处。目的：本研究旨在比较DC与BMT单独治疗sICH在功能神经预后、死亡率和住院时间方面的差异。方法：对sICH患者进行随机和观察性研究，比较手术（DC）和单独保守治疗。分析的结果包括修改的兰金量表（mRS）、30天、90天死亡率、总死亡率和住院时间。计算二元结局和连续结局的优势比（OR）和平均差（MD）。结果：我们的分析包括8项研究（n=743）， 345例患者接受手术治疗，398例患者接受保守治疗。BMT单独与神经功能差相关（mRS为5-6）(OR 0.44；95% ci 0.24-0.78；假定值0.005;手术组的神经功能良好率（mRS 0-4）高于手术组(OR 2.29；95% ci 1.28 - 4.10；p 0.005;I2 39,8%)，尽管mRS 0-2缺乏统计学意义(OR 1.25；95% ci 0.47-3.33；p 0.66;I2 0%)和mRS 0-3 (OR 1.43；95% ci 0.82-2.51；p 0.21;I2 0%)。保守治疗与较高的30天死亡率相关(OR 0.36；95% ci 0.19-0.66；假定值0.001;I2 %)，在90天(OR 0.35；95% ci 0.14-0.86；p 0.022;I2 68.7%)，最后随访(OR 0.33；95% ci 0.21-0.52；p值< 0.001；I2 34岁的8%)。住院时间DC组优于DC组，但无统计学意义(MD 16.05；95% ci -3.24-35.34；假定值0.1;I2 92年9%)。结论：在siich患者中，与单纯BMT相比，减压颅骨切除术显示出降低死亡率和改善神经功能的潜力。需要采用改进的方法进行进一步的随机研究，以提高证据的质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.