Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China.
Department of Neurosurgery, The Affiliated Jiangyin hospital of Nantong University, Jiangyin, China.
World Neurosurg. 2024 Jul;187:e585-e597. doi: 10.1016/j.wneu.2024.04.132. Epub 2024 Apr 26.
Debate persists over the relative merits of neuroendoscopic surgery (NS) compared to stereotactic aspiration (SA) for treating supratentorial intracerebral hemorrhage (ICH). Consequently, we undertook this meta-analysis to assess the efficacy and safety of NS versus SA.
We searched for the all-relevant studies systematically from English databases including PubMed, Embase, Web of Science, and the Cochrane Library. Three 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.
Sixteen studies, including 2722 supratentorial ICH patients, were included in our meta-analysis. The pooled results showed that NS could effectively improve the functional prognosis (P = 0.002), reduce the postoperative mortality (P < 0.00001), and increase the hematoma evacuation rate (P < 0.00001). In addition, SA had more advantages in shortening operation time (P < 0.00001) and reducing intraoperative blood loss (P < 0.0001). However, there was no obvious statistical difference in intensive care unit stays (P = 0.23) between NS and SA. Besides, no sufficient evidence could support a significant difference in hospital stays. In the aspect of complications, NS was discovered to have a positive effect on preventing rebleeding (P = 0.005) and intracranial infection (P = 0.003). However, no significant differences between the 2 groups in digestive tract ulcer (P = 0.34), epilepsy (P = 0.99), and pneumonia (P = 0.58) were discovered. In the subgroup analysis, factors including publication time, Glasgow Coma Scale score, age, and follow-up, all significantly influenced the good functional outcome and mortality. Meanwhile, NS behaved more advantageous in improving functional prognosis for patients with hematoma located in the basal ganglia.
NS may hold more advantages over SA in the treatment of supratentorial ICH. However, SA is also an effective and suitable alternative for elderly patients, especially those with multiple comorbidities intolerant to extended surgical procedures. Further high-quality studies are warranted to substantiate our findings in the future.
神经内镜手术（NS）与立体定向抽吸（SA）治疗幕上脑内血肿（ICH）的相对优势仍存在争议。因此，我们进行了这项荟萃分析，以评估 NS 与 SA 的疗效和安全性。
我们从包括 PubMed、Embase、Web of Science 和 Cochrane 图书馆在内的英文数据库中系统地搜索了所有相关研究。三名独立的研究人员根据纳入标准确定并选择了这些文献。然后，我们根据 Cochrane 协作风险偏倚工具和纽卡斯尔-渥太华量表评估这些研究的质量。RevMan 5.4 统计软件用于进行这项荟萃分析。
共有 16 项研究，包括 2722 例幕上 ICH 患者，纳入了我们的荟萃分析。汇总结果表明，NS 可有效改善功能预后（P=0.002），降低术后死亡率（P<0.00001），并提高血肿清除率（P<0.00001）。此外，SA 在缩短手术时间（P<0.00001）和减少术中失血（P<0.0001）方面具有更多优势。然而，NS 和 SA 之间在重症监护病房停留时间（P=0.23）方面没有明显的统计学差异。此外，没有足够的证据支持住院时间的显著差异。在并发症方面，NS 被发现对预防再出血（P=0.005）和颅内感染（P=0.003）有积极作用。然而，两组之间在消化道溃疡（P=0.34）、癫痫（P=0.99）和肺炎（P=0.58）方面没有发现显著差异。在亚组分析中，包括发表时间、格拉斯哥昏迷量表评分、年龄和随访在内的因素都显著影响了良好的功能预后和死亡率。同时，NS 在改善基底节血肿患者的功能预后方面具有更大的优势。
NS 在治疗幕上 ICH 方面可能优于 SA。然而，SA 也是一种有效且适合老年患者的替代方法，特别是那些不能耐受延长手术的患者。未来需要进一步进行高质量的研究来证实我们的研究结果。
