Original Article
Stereotactic-Guided Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage: Systematic Review and Meta-Analysis Taiwo Akhigbe, Uchena Okafor, Taufiq Sattar, Daniel Rawluk, Tom Fahey
BACKGROUND: Spontaneous intracerebral hemorrhage (SICH) has a high morbidity and mortality and places a huge significant economic burden on health care and social services. The role of surgery is still controversial as evidenced by wide variation internationally in management of SICH. Traditional surgery for SICH involved open craniotomy with hematoma evacuation. Using available evidence, this article assesses the efficacy of stereotacticguided evacuation compared with medical treatment.
compared with patients who received medical treatment; however, there was a trend toward better quality of survival and chance of survival in the stereotactic-guided evacuation group. This study identified areas for further research.
METHODS: A systematic review was performed comparing stereotactic-guided evacuation of SICH with conservative medical management. Eligible studies were identified using a text word search of an electronic journal database for randomized controlled trials. Extracted data outcomes were subjected to meta-analysis with a forest plot. Quality was assessed using Cochrane risk of bias analysis tools.
pontaneous supratentorial intracerebral hemorrhage (SICH) has a high morbidity and mortality and places a significant economic burden on health care and social services. The annual incidence is about 20 cases per 100,000 population (9). Death or a dependent state is the outcome in >70% of patients (19). SICH causes 10%e15% of first-time strokes with a 30-day mortality rate of 35%e52%, with half of deaths occurring in the first 2 days (1). The role of surgery is controversial, as evidenced by wide variation internationally in its use. Traditionally, surgery for SICH involved open craniotomy and hematoma evacuation. Several meta-analyses (19) and randomized controlled trials (RCTs) (10) failed to demonstrate significant benefit. Classic open craniotomy may traumatize the brain tissue further with no evidence that it reduces mortality (19). A minimally invasive technique such as stereotactic evacuation combines the benefit of surgical clot evacuation with limited tissue damage, shorter duration of surgery, and the possibility of using local anesthesia. Conventional craniotomy has a mortality rate of 25% at 3 months, and 58.9% of patients who undergo the procedure have a poor outcome (17). Alternative procedures include stereotactic aspiration and endoscopic evacuation (8). Stereotactic aspiration to treat deep-seated basal ganglia has gained wide acceptance
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RESULTS: There were 5 studies with 740 patients. There was a nonsignificant reduction in odds ratio (OR) for death at the end of the follow-up period (OR [ 0.74, 95% confidence interval [ 0.45e1.21) with no significant heterogeneity. Nonsignificant benefits were observed for dependent survival (OR [ 2.14, 95% confidence interval [ 0.31e0.58). In the subgroup analysis, stereotactic evacuation showed improved outcomes in patients with hematoma volume 90 for the stereotactic evacuation group, which is in keeping with independent functional outcome; for mRS score, both studies reported
Stereotactic-Guided Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage: Systematic Review and Meta-Analysis Taiwo Akhigbe, Uchena Okafor, Taufiq Sattar, Daniel Rawluk, Tom Fahey
BACKGROUND: Spontaneous intracerebral hemorrhage (SICH) has a high morbidity and mortality and places a huge significant economic burden on health care and social services. The role of surgery is still controversial as evidenced by wide variation internationally in management of SICH. Traditional surgery for SICH involved open craniotomy with hematoma evacuation. Using available evidence, this article assesses the efficacy of stereotacticguided evacuation compared with medical treatment.
compared with patients who received medical treatment; however, there was a trend toward better quality of survival and chance of survival in the stereotactic-guided evacuation group. This study identified areas for further research.
METHODS: A systematic review was performed comparing stereotactic-guided evacuation of SICH with conservative medical management. Eligible studies were identified using a text word search of an electronic journal database for randomized controlled trials. Extracted data outcomes were subjected to meta-analysis with a forest plot. Quality was assessed using Cochrane risk of bias analysis tools.
pontaneous supratentorial intracerebral hemorrhage (SICH) has a high morbidity and mortality and places a significant economic burden on health care and social services. The annual incidence is about 20 cases per 100,000 population (9). Death or a dependent state is the outcome in >70% of patients (19). SICH causes 10%e15% of first-time strokes with a 30-day mortality rate of 35%e52%, with half of deaths occurring in the first 2 days (1). The role of surgery is controversial, as evidenced by wide variation internationally in its use. Traditionally, surgery for SICH involved open craniotomy and hematoma evacuation. Several meta-analyses (19) and randomized controlled trials (RCTs) (10) failed to demonstrate significant benefit. Classic open craniotomy may traumatize the brain tissue further with no evidence that it reduces mortality (19). A minimally invasive technique such as stereotactic evacuation combines the benefit of surgical clot evacuation with limited tissue damage, shorter duration of surgery, and the possibility of using local anesthesia. Conventional craniotomy has a mortality rate of 25% at 3 months, and 58.9% of patients who undergo the procedure have a poor outcome (17). Alternative procedures include stereotactic aspiration and endoscopic evacuation (8). Stereotactic aspiration to treat deep-seated basal ganglia has gained wide acceptance
-
-
RESULTS: There were 5 studies with 740 patients. There was a nonsignificant reduction in odds ratio (OR) for death at the end of the follow-up period (OR [ 0.74, 95% confidence interval [ 0.45e1.21) with no significant heterogeneity. Nonsignificant benefits were observed for dependent survival (OR [ 2.14, 95% confidence interval [ 0.31e0.58). In the subgroup analysis, stereotactic evacuation showed improved outcomes in patients with hematoma volume 90 for the stereotactic evacuation group, which is in keeping with independent functional outcome; for mRS score, both studies reported
