Different surgical interventions for patients with spontaneous supratentorial intracranial hemorrhage: A network meta-analysis.
OBJECTIVE
This study was performed to explore the efficacy and safety of different surgical interventions in patients with spontaneous supratentorial intracranial hemorrhage (SSICH) and determine which intervention is most suitable for such patients.


PATIENTS AND METHODS
We searched the PubMed, Medline, OVID, Embase, and Cochrane Library databases. The quality of the included studies was assessed. Statistical analyses were performed using the software Stata 13.0 and RevMan 5.3.


RESULTS
Endoscopic surgery (ES), minimally invasive surgery combined with urokinase (MIS + UK), minimally invasive surgery combined with recombinant tissue plasminogen activator (MIS + rt-PA), and craniotomy were associated with higher survival rates and a lower risk of intracranial rebleeding than standard medical care (SMC) in patients with SSICH, especially in younger patients with few comorbidities. The order from highest to lowest survival rate was ES, MIS + UK, MIS + rt-PA, craniotomy, and SMC. The order from lowest to highest intracranial rebleeding risk was ES, MIS + UK, craniotomy, MIS + rt-PA, and SMC. Additionally, compared with SMC, all four surgical interventions (ES, MIS + rt-PA, MIS + UK, and craniotomy) improved the prognosis and reduced the proportion of patients with serious disability. The order from most to least favorable prognosis was MIS + rt-PA, ES, MIS + UK, craniotomy, and SMC. The order from highest to lowest proportion of patients with serious disability was ES, MIS + rt-PA, MIS + UK, craniotomy, and SMC.


CONCLUSIONS
This study revealed that the efficacy and safety of different surgical interventions (ES, MIS + UK, MIS + rt-PA, craniotomy) were superior to those of SMC in the patients with SSICH, especially in younger patients with few comorbidities. Among them, ES was the most reasonable and effective intervention. ES was found not only to improve the survival rate and prognosis but also to have the lowest risk of intracranial rebleeding and the lowest proportion of patients with serious disability.
['Li|Mei|M|', 'Mu|Fengqun|F|', 'Su|Dongpo|D|', 'Han|Qian|Q|', 'Guo|Zhenzhong|Z|', 'Chen|Tong|T|']
D020145:Basal Ganglia Hemorrhage D003131:Combined Modality Therapy D003399:Craniotomy D004322:Drainage D005343:Fibrinolytic Agents D000083302:Hemorrhagic Stroke D006801:Humans D020300:Intracranial Hemorrhages D019060:Minimally Invasive Surgical Procedures D000071076:Network Meta-Analysis D044583:Neuroendoscopy D019635:Neurosurgical Procedures D020146:Putaminal Hemorrhage D012008:Recurrence D015996:Survival Rate D013786:Thalamic Diseases D010959:Tissue Plasminogen Activator D016896:Treatment Outcome D014568:Urokinase-Type Plasminogen Activator
Supratentorial intracranial hemorrhage Network meta-analysis Endoscopic surgery Minimally invasive Craniotomy