Clinical benefits of invasive intracranial pressure monitoring for spontaneous intracranial hemorrhage: a systematic review and meta-analysis.

Background: This meta-analysis evaluated the clinical benefits of invasive intracranial pressure (ICP) monitoring for spontaneous intracranial hemorrhage with specific focuses on the hypertensive intracerebral hemorrhage (ICH) subgroup and the outcomes when combined with minimally invasive surgery (MIS).

Methods: PubMed and Embase were searched to identify studies comparing the clinical outcomes from ICP monitoring vs. non-ICP monitoring. Primary outcomes included in-hospital and 6-month mortality rates. Secondary outcomes were hospital length of stay (LOS), proportion of patients with poor 6-month functional outcomes, and central nervous system (CNS) infection rates. Subgroup analyses were performed on hypertensive ICH subgroup and on MIS vs. non-MIS subgroups. This study was registered in PROSPERO (CRD42024587974).

Results: Thirteen studies involving 4,027 patients with spontaneous intracranial hemorrhage were included. Compared with non-ICP monitoring, ICP monitoring significantly reduced the 6-month mortality rate (43.33% vs. 28.67%, P < 0.00001), the proportion of patients with poor 6-month functional outcomes (70.49% vs. 56.71%, P = 0.0003), and hospital LOS (19.71 vs. 18.15 days, P = 0.001) but increased CNS infection rate (1.56% vs.7.49%, P < 0.00001). The hypertensive ICH subgroup analysis revealed that ICP monitoring significantly reduced in-hospital mortality rate (8.57% vs. 2.78%, P = 0.02), LOS (18.42 vs.14.54 days, P < 0.00001), and the proportion of patients with poor 6-month functional outcomes (60.00% vs. 38.77%, P = 0.001). When used with MIS, ICP monitoring significantly reduced the LOS (16.98 vs. 12.45 days, P < 0.00001) and the proportion of patients with poor 6-month functional outcomes (66.89% vs. 36.22%, P < 0.00001).

Conclusion: ICP monitoring improves short- and long-term outcomes in patients with spontaneous intracranial hemorrhage, particularly when combined with MIS therapy.