Craniotomy versus endoscopic approach in basalganglia haemorrhage: A systematic review andmeta-analysis

[摘要] Objectives: Basal ganglia haemorrhage (BGH) is the most common type of intracerebral bleed withhigh morbidity and mortality rate. Despite advancements in minimally invasive techniques in recentyears, the efficacy between craniotomy and endoscopic approach for BGH is still debatable. Theaim of this systematic review and meta-analysis was to evaluate the outcomes of craniotomy andendoscopic approach for BGH. Methods: Databases of Pubmed, EMBASE, MEDLINE and CENTRALwere systematically searched from its inception until December 2020. All randomized clinical trialsand observational studies comparing craniotomy versus endoscopic approach in BGH were included.Results: Twelve studies enrolling 1,297 patients (craniotomy:675, endoscopy:632) were included forqualitative and quantitative analysis. Endoscopic approach was associated with significantly lowerpostoperative mortality (OR:0.35, P<0.001), higher haematoma evacuation rate (MD:4.95, P<0.001),shorter operative time (MD:-117.03, P<0.001), lower intraoperative blood loss (MD:-328.47, P<0.001),higher postoperative Glasgow Coma Scale (GCS) (MD:1.14, P=0.01), higher postoperative GlasgowOutcome Scale (GOS) (MD:0.44, P=0.05), shorter length of hospital stay (MD:-2.90, P<0.001), lowercomplication rate (OR:0.30, P=0.001), lower infection rate (OR:0.29, P<0.001) and lower modifiedRankin Scale (mRS) (MD:-0.57, P=0.004) compared to craniotomy. No significant difference wasdetected in re-operation, and re-bleeding.Conclusion: The best available evidence suggest that endoscopic approach has better outcomesin mortality rate, operative time, haematoma evacuation rate, intraoperative blood loss, length ofhospital stay, mRS, postoperative GCS and GOS compared with craniotomy in the management ofBGH. However, there is a need for high quality randomised controlled trials with large sample sizefor definitive conclusions.

[学科分类] 精神健康和精神病学

[关键词] Endoscopy;craniotomy;basal ganglia haemorrhage;meta-analysis