• Abdul Haseeb, Muhammad Ashir Shafique, Muhammad Saqlain Mustafa, Ajeet Singh, Sadaf Iftikhar, Burhanuddin Sohail Rangwala, Anzah Imtiaz Waggan, Tagwa Kalool Fadlalla Ahmad, Sandesh Raja, and Adarsh Raja.
• Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
• World Neurosurg. 2024 Oct 1; 190: e721e747e721-e747.

BackgroundIntracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuroendoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compared the effectiveness of NES versus craniotomy in treating ICH.MethodsA systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials or observational studies for confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using meta-analysis software.ResultsThe analysis included 26studies (N = 3237 patients). NES was associated with significantly lower mortality compared with craniotomy (odds ratio 0.45, 95% confidence interval [CI] 0.33 to 0.60, P < 0.00001). Hematoma evacuation rates were higher with NES (standardized mean difference 1.505, 95% CI 0.835 to 2.160, P < 0.00001). NES also showed better functional outcomes (odds ratio 3.31, 95% CI 1.78 to 6.17, P = 0.0002) and reduced blood loss (standardized mean difference -3.06, 95% CI -3.979 to -2.141, P = 0.000). Additionally, NES was associated with shorter hospital and intensive care unit stays, shorter operative times, and fewer complications such as infection and rebleeding.ConclusionsNES is a promising alternative to craniotomy for treating ICH, offering advantages in terms of reduced mortality, improved functional outcomes, and fewer complications. Future studies should explore advances in neuroendoscopic techniques to optimize patient outcomes further.Copyright © 2024 Elsevier Inc. All rights reserved.

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