Neuroendoscopic Surgery versus Stereotactic Aspiration in the treatment of supratentorial intracerebral hemorrhage: a meta-analysis

Abstract Background No consensus has been reached on the superiority between Neuroendoscopic Surgery (NS) versus Stereotactic Aspiration (SA) in the treatment of supratentorial intracerebral hemorrhage (ICH). Therefore, this study conducted in-depth analysis and aimed to evaluate the efficacy and safety of NS versus SA for supratentorial ICH. Methods We searched for the all-relevant studies systematically from English databases including PubMed, Embase, Web of Science and the Cochrane Library. Two independent researchers identified and selected these literatures that met the inclusion criteria. Then we evaluated the quality of these studies according to the Cochrane Collaboration’s risk of bias tool and the Newcastle-Ottawa Scale. RevMan 5.4 statistical software was used to conduct this meta-analysis. Results Fifteen studies, including 2600 supratentorial ICH patients, were included in our meta-analysis. The pooled results showed that NS could effectively reduce the postoperative mortality (P < 0.00001) and increase the hematoma evacuation rate (P < 0.00001). However, no significant difference was found between NS and SA in improving the functional prognosis (P = 0.15). In the aspect of hospital stays (P < 0.00001), no enough evidence could support that SA could shorten the hospital stays better than NS. However, SA had more advantages in shortening operation time (P < 0.00001) and reducing intraoperative blood loss (P < 0.00001). In the aspect of complications, NS could have a positive effect on preventing intracranial infection (P = 0.004). In the subgroup analysis, we found that Initial GCS might be a risk factor affecting prognosis and hematoma volume might be an important factor affecting mortality. Conclusion NS might have more advantages than SA in the treatment of supratentorial ICH. However, SA was also an effective alternative for middle-aged and elderly patients. More high-quality studies were needed to verify our conclusions in the future.