Minimally invasive surgery for non-traumatic spontaneous intracerebral Hemorrhage: A network Meta-Analysis of multiple treatment modalities

Introduction: Spontaneous Supratentorial Intracerebral Hemorrhage (SICH) is a severe condition with high mortality and morbidity, annually affecting around 2 million people globally. Current treatment guidelines emphasize medical management however, Minimally Invasive Surgery (MIS), including stereotactic and endoscopic approaches, has shown promise in improving outcomes. This network meta-analysis aims to compare the efficacy and safety of MIS with conventional craniotomy, burrhole catheter insertion, and medical treatment for the management of SICH. Methods: Following PRISMA guidelines, a comprehensive literature search across three databases to identify relevant studies. Data extracted included demographics, treatment outcomes, and adverse effects, while the quality of studies was assessed using the NHLBI tool. A network meta-analysis was performed using RStudio to compare the effectiveness of MIS approaches with other treatment modalities. Results: MIS for SICH was more effective than conservative medical management in reducing mortality (OR: 1.991; 95% CI, 1.364-2.907) but did not show a mortality benefit compared to conventional surgery, external ventricular drainage (EVD), or burr hole procedures. MIS had similar hematoma evacuation rates to conventional surgery and burr hole drainage but required significantly less operating time (SMD: 3.837; 95% CI, 2.851-4.823) and reduced ICU stay (SMD: 4.436; 95% CI, 2.386-6.486). Conventional surgery had higher risks of blood loss, seizures, GI bleed/ulceration, and pneumonia/RTI, while MIS showed a safer profile regarding these complications. There was no significant difference in rebleeding (OR: 1.492; 95% CI, 0.632-3.522) or reoperation rates (OR: 0.494; 95% CI, 0.120-2.039) between MIS, conventional surgery, and conservative treatment. Conclusion: MIS significantly reduces mortality compared to conservative treatment while offering similar outcomes to other surgeries. MIS also has advantages like shorter operating times, reduced ICU stays, and fewer complications, making it a promising alternative for managing SICH.