Brain and behavior
Minimally Invasive Hematoma Evacuation for Acute Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis With Trial Sequential Analysis
By Saleem S, Bacha Z, Khan K and 12 others.
Abstract
Background
Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high morbidity and mortality. While surgical evacuation aims to reduce hematoma burden and improve outcomes, its clinical benefit over medical management remains uncertain. Previous systematic reviews have evaluated a broad range of surgical interventions for ICH; however, evidence specific to MIS remains less clearly defined. Therefore, we performed a systematic review and meta-analysis to assess the efficacy and safety of minimally invasive hematoma evacuation in patients with acute spontaneous supratentorial ICH.
Methods
This meta-analysis was performed in accordance with PRISMA 2020 guidelines and Cochrane recommendations. A comprehensive search of MEDLINE, Embase, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to February 2026. We included randomized controlled trials that compared minimally invasive hematoma evacuation with medical or conventional surgical management. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model.