179 Clinical Outcomes of Minimally Invasive Surgical Interventions Versus Medical Management in Intracerebral Hemorrhage: A Meta-Analysis

INTRODUCTION: In recent years, there has been widespread utilization of various neurosurgical techniques aimed at optimizing outcomes and prognoses in patients with intracerebral hemorrhage (ICH). Minimally invasive surgery (MIS) approaches have demonstrated superior efficacy relative to conventional medical management (MM). An updated meta-analysis is imperative for assessing the efficacy of MIS strategies in patients presenting with (ICH). METHODS: A meta-analysis was conducted by screening randomized interventional studies and non-randomized interventional studies that compared the use of medical management and any MIS for the treatment of ICH. Main outcomes included rebleeding after surgery, mortality rate, infection rate and length of stay. Outcomes were analyzed pooling the treatment effect as Risk Ratios (RR) through a random-effects model using the Mantel-Haenszel method and Inverse variance method. Statistical analysis was made using RevMan5 and RStudio software. RESULTS: Among 709 studies screened, 6 references were considered for quantitative synthesis. A total of 882 patients were included, 447 of these were treated with MM and 435 patients were treated with MIS. Meta-analysis of rebleeding after surgery outcome showed an overall significant decrease in rebleeding rates of patients treated with MM compared with MIS (Overall RR [CI95%] 0.52 [0.45-0.59], p=<0.001). MIS showed an overall significant decrease in mortality rate ( Overall RR [CI95%] 1.62 [1.07-2.43], p=0.02) compared with MM. In the infection and length of stay outcomes there were no significant differences between both groups evaluated in the quantitative synthesis. CONCLUSIONS: The use of MIS for surgical removal in ICH can improve the rebleeding frequency and mortality rate compared to MM, but it did not affect infection and length of stay. These results can provide valuable information for future interventions in ICH patients.