Effectiveness and Safety of Minimally Invasive Surgery for Infratentorial Hemorrhages: A Meta-Analysis of Clinical and Technical Outcomes

Abstract Spontaneous infratentorial hemorrhages (SIHs) are a type of hemorrhagic stroke that compromise the cerebellum and/or brainstem. While minimally invasive surgical (MIS) approaches are effective in treating spontaneous supratentorial hemorrhage, their efficacy in managing SIH remains unclear. This uncertainty prompted the undertaking of this systematic review and meta-analysis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive search of the PubMed, Scopus, and Cochrane Library databases. Studies were included if they had a minimum of five patients and reported at least one outcome of interest. The outcomes evaluated were technical success, mean hematoma reduction, good functional outcomes at 3- and 6-month follow-up, complication rates, rebleeding rates, and postoperative mortality. A subgroup analysis was performed based on hemorrhage location and surgical approach. Depending on the data, either a random-effects or common-effects model was applied, and heterogeneity was assessed using I 2 statistics. Seventeen studies met inclusion criteria. Postoperative mortality was 14.34% (95% confidence interval [CI]: 8.94–19.74%). Rate of good functional outcomes were 46.82% (95% CI: 18.88–74.77%) and 50.95% (95% CI: 32.72–69.17%) at 3 and 6 months, respectively. The overall complication rate was 6.86% (95% CI: 3.03–10.69%). Mortality by surgical technique ranged from 6.72% (miniature craniotomy only) to 26.27% (miniature craniotomy and catheter/puncture drainage), with no significant differences between approaches (p = 0.08). Patients with cerebellar hemorrhage experienced significantly greater rates of good functional outcome at 6 months compared with those with brainstem hemorrhage (p = 0.0004). Our study suggests that MIS for the treatment of SIH is an effective and feasible approach, as evidenced by low mortality rates and a limited number of associated complications. Larger randomized studies are warranted to compare different strategies and further optimize patient care.