Abstract 4138167: Comparative Efficacy Of Minimally Invasive Versus Standard Treatments For Intracerebral Hemorrhage: A Meta-Analysis and Systemic Review

Background: Intracerebral hemorrhage (ICH) has high morbidity and mortality. Traditional craniotomy causes significant trauma and lacks proven benefits. Minimally invasive techniques (MIT) like CT-guided thrombolysis, endoscopic, and neuronavigation surgeries show promise in reducing secondary neurotoxicity. Our meta-analysis compares MIT with standard treatments for supratentorial spontaneous intracerebral hematomas (SSICHs) to evaluate their effectiveness in improving clinical outcomes. Methods: We comprehensively searched PubMed, EMBASE, and Cochrane Library for studies published before June 1, 2024, comparing MIT versus standard treatment for ICH. Data were analyzed using R (v.4.3). Pooled proportions with 95% confidence intervals (CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% CIs were used for dichotomous and continuous variables. Outcomes included overall survival, functional neurological outcome, hospitalization length, recurrent bleeding, volume reduction, and Glasgow Coma Scale (GCS) score at discharge. Results: We identified six studies, including 1,117 patients. There were 463 patients who underwent MIT and 654 patients who received standard treatment. The MIT group exhibited statistically significant increased odds of survival (OR: 1.98 [1.25, 3.15]; I2=26%; p=0.004) and functional neurological outcome (OR: 1.94 [1.27, 2.96]; I2=25%; p=0.002) compared to the standard treatment group. The MIT group demonstrated statistically significant lower length of hospitalization (MD: -2.89 [-4.49, -1.30]; I2=47%; p=0.0004) and better GCS score at discharge (MD: 1.50 [1.00, 2.00]; I2=0%; p<0.00001) compared to the standard treatment group. The MIT group also showed a trend towards more volume reduction (MD: 12.33 [-11.39, 36.05]; I2=99%; p=0.31) and lesser odds of recurrent bleeding (OR: 0.71 [0.25, 1.99]; I2=15%; p=0.52) compared to the standard treatment group, but these were not statistically significant. Conclusion: MIT show superior outcomes in survival, functional neurological status, hospitalization length, and GCS scores at discharge compared to standard treatments for SSICHs. While trends towards greater volume reduction and lower bleeding recurrence were observed, they were not statistically significant. Further research is needed to optimize MIT and confirm its benefits in larger, randomized trials.