Surgical interventions for spontaneous supratentorial intracerebral haemorrhage: a systematic review and network meta-analysis
Notice bibliographique
Résumé
Background Surgical interventions for spontaneous supratentorial intracerebral haemorrhage (ICH) include conventional craniotomy (CC), decompressive craniectomy (DC), and minimally invasive surgery (MIS), with the latter encompassing endoscopic surgery (ES) and minimally invasive puncture surgery (MIPS). However, the superiority of surgery over conservative medical treatment (CMT) and the comparative benefits of different surgical procedures remain unclear. We aimed to evaluate the efficacy and safety of various surgical interventions for treating ICH. Methods In this systematic review and network meta-analysis, we searched PubMed, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov from inception to June 16, 2024. Eligible studies were randomised controlled trials (RCTs) comparing surgery (i.e., CC, ES, MIPS, or DC) with CMT or comparing different types of surgeries in patients with spontaneous supratentorial ICH. Paired reviewers independently screened citations, assessed the risk of bias of included trials, and extracted data. Primary outcomes were good functional outcome and mortality at 6 months. Secondary outcomes were good functional outcome and mortality at different follow-up times, complications (rebleeding, brain infection, pulmonary infection), and hematoma evacuation rate. The frequentist pairwise and network meta-analysis (NMA) were performed. The GRADE approach was used to evaluate the certainty of evidence. This study is registered with PROSPERO, CRD42024518961. Findings Of the 8573 total records identified by our searches, 31 studies (6448 patients) were eligible for the systematic review and network analysis. Compared with CMT, moderate certainty evidence showed that surgery improved good functional outcome (risk ratio [RR] 1.31, 95% CI 1.13–1.52; risk difference [RD] 9.1%, 95% CI 3.8 to 15.3; I 2 = 36%) and reduced mortality (RR 0.82, 95% CI 0.71–0.95; RD −5.1%, 95% CI −8.2 to −1.4; I 2 = 14%). Moderate certainty evidence from NMA suggested that compared with CMT, both ES (RR 1.51, 95% CI 1.18–1.93; RD 9.4%, 95% CI 3.3–17.1) and MIPS (RR 1.48, 95% CI 1.24–1.76; RD 15.7%, 95% CI 7.9–24.9) improved good functional outcome at 6 months, and both ES (RR 0.66, 95% CI 0.52–0.85; RD −17.0%, 95% CI −24.0 to −7.5) and CC (RR 0.75, 95% CI 0.60–0.94; RD −6.3%, 95% CI −10.1 to −1.5) reduced mortality at 6 months, whereas MIPS and DC showed a trend, although not statistically significant, towards a reduction in mortality. ES and MIPS also reduced pulmonary infection risk (ES RR 0.39, 95% CI 0.23–0.69; MIPS RR 0.35, 95% CI 0.20–0.60; RD −5.3%, 95% CI −6.6 to −3.3). ES showed higher hematoma evacuation than CC (MD: 7.03, 95% CI: 3.42–10.65; I 2 = 94%). No difference in rebleeding or brain infection was found between CC and MIS. Interpretation Current moderate certainty evidence suggested that surgical intervention of spontaneous supratentorial ICH, may be associated with improved functional outcomes and a reduced risk of death at 6 months. The advantages of surgical haematoma removal are particularly pronounced when MIS including ES and MIPS are employed. ES could improve functional outcomes, reduce the risk of mortality and pulmonary infection, and have a high hematoma evacuation rate, suggesting that it might be an optimal surgical treatment. Funding National Natural Science Foundation of China, National Science Fund for Distinguished Young Scholars, Fundamental Research Funds for the Central Public Welfare Research Institutes, and 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,026 | 0,017 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».