Surgical versus conservative Management of Primary lobar Intracerebral Hematoma A SYSTEMATIC REVIEW

Abstract

Background: The balance of risk and benefit from early neurosurgical intervention for conscious patients withsuperficial lobar intracerebral hemorrhage of 10–100 mL and no intraventricular hemorrhage admitted within 48 hof ictus is unclear. We therefore tested the hypothesis that early surgery compared with initial conservative treatment Could improve outcome in these patients. Method: In this study, 7 RCTs were included all done on patients with lobar intracerebral hemorrhage. We assessed the participants, methods, and intervention effects of included studies for heterogenecity. This enabled us determine whether results can be pooled across studies. Any identified clinical or statistical heterogenecity was explored visually or using the chi square test. In case of heterogenecity, subgroup analyses according to these different categories was conducted. If included studies are similar enough to combine, a fixed-effect meta-analysis was conducted. Findings: 562of 1126 patients were randomly assigned to early surgery and 564 to initial conservative treatment; Total no. of patients with lobar hemorrhages was 562 patients in the surgical group and 564 in the medical group, after exclusion of (Morgan et al. 2008)’s population due to un-extractable data. 211 of 562 patients (37.5%) in the surgical group had favorable outcome, while 183 of 564 patients (32.4%) in the medical group did. Interpretation: Upon data retrieved from our review, it is evident both interventions for treatment of lobar ICH has nearly equal results. However, surgical intervention gives slightly better results. These results could be attained by surgical intervention to a well selected population; regarding their age, GCS and timing of intervention. Younger age, between 50 and 79 years, in patients with GCS between 9 to 12 could benefit from surgical intervention if done within 12 to 24 hours of ictus