Anik Ihsan, Secer Halil Ibrahim, Anik Yonca, Duz Bulent, Gonul Engin
Kocaeli University, Faculty of Medicine, Department of Neurosurgery, Kocaeli, Turkey.
Turk Neurosurg. 2011 Jan;21(1):6-14.
The aim of this study is to define the position of surgery preference in the treatment choice for spontaneous intracerebral hematoma (ICH) and to compare the efficacy of surgery with the medical treatment based on data from 18 previously reported randomized prospective studies on this topic.
Literature databases and articles were searched from 1960 to 2010. Eighteen randomized studies on this topic were evaluated.
Among these 18 studies, 7 (38.9%) were multicenter and 11 (61.1%) were single center. Totally 204 centers were involved. 1769 patients were treated surgically and 3200 medically. Craniotomy was the most preferred method (n = 14; 77.8%). Follow-up time was mostly 6 months. In general, the effect of surgical versus medical treatment on outcome (mortality/morbidity) after a supratentorial spontaneous ICH do not differ significantly. In individual analysis, the mortality was found to be significantly lower in the operated group than the nonoperated group in only two studies (Kurtsoy's and Miller's studies). Meta-analysis of subgroup analysis revealed surgical treatment results were significantly better for hematoma volume > 40 ml, early surgery (before 24 hours), and Glasgow Coma Scale (GCS)≥ 6.
Surgical treatment results were found to be superior to medical treatment in cases with hematoma volume > 40 ml, and GCS ≥ 6. The studies are not adequate to analyze the best type of surgery.
本研究旨在明确手术治疗在自发性脑内血肿（ICH）治疗选择中的地位，并基于此前报道的18项关于该主题的随机前瞻性研究数据，比较手术治疗与保守治疗的疗效。
检索1960年至2010年的文献数据库及文章。对18项关于该主题的随机研究进行评估。
在这18项研究中，7项（38.9%）为多中心研究，11项（61.1%）为单中心研究。共涉及204个中心。1769例患者接受手术治疗，3200例接受保守治疗。开颅手术是最常用的方法（n = 14；77.8%）。随访时间大多为6个月。总体而言，幕上自发性ICH后手术治疗与保守治疗对预后（死亡率/发病率）的影响无显著差异。在个体分析中，仅在两项研究（Kurtsoy研究和Miller研究）中发现手术组死亡率显著低于非手术组。亚组分析的Meta分析显示，对于血肿体积>40 ml、早期手术（24小时内）及格拉斯哥昏迷量表（GCS）≥6的患者，手术治疗效果显著更好。
对于血肿体积>40 ml且GCS≥6的患者，手术治疗效果优于保守治疗。现有研究不足以分析最佳手术方式。
