Effect of minimally invasive surgery on mortality and favorable functional outcome in patients with spontaneous supratentorial intracerebral hemorrhage compared to standard medical treatment: a systematic review and meta-analysis of randomized contro

Intracerebral hemorrhage is responsible for the 10-15% of strokes and is associated with high morbidity and mortality. The role of surgical intervention in the management of patients with intracerebral hemorrhage remains controversial. The aim of this systematic review and meta-analysis was to investigate the effect of minimally invasive surgery in patients with spontaneous supratentorial intracerebral hemorrhage on mortality and favorable functional outcome compared to standard medical treatment, based on the results of relevant randomized controlled trials. Methods: PubMed and Cochrane were searched until 19 October 2024. Primary outcomes were mortality at 30 days and favorable functional outcome at 180 days defined as score 0-3 in modified Rankin Scale. Secondary outcomes were recurrence of hemorrhage and any complications. Results: 7 Randomized controlled trials and 1458 patients were included. The odds ratio for mortality at 30 days was lower in the minimally invasive surgery group compared to the standard medical treatment group (OR=0.63, [0.42, 0.93], p=0.02, I2=0%, p=0.51). Also, the odds of favorable functional outcome at 180 days were higher in the minimally invasive group compared to the standard medical treatment group (OR=1.55, [1.06, 2.25] p=0.02, I2=0%, p=0.7), however the odds of hemorrhage recurrence were also higher in the minimally invasive group compared to the standard medical treatment group (OR=3.86, [2.52, 5.90] p<0.0001, I2=6%, p=0.37). Conclusions: Patients with spontaneous supratentorial ICH who had minimally invasive surgery although experienced higher rebleeding rates, demonstrated lower mortality at 30 days and better functional outcome at 180 days in comparison with the standard medical treatment group.