Title: Comparing Various Surgical Interventions Versus Conservative Medical Treatment In Spontaneous Supratentorial Intracerebral Hemorrhage: A Network Meta-Analysis Of The Randomized Controlled Trials
Authors: Muhammad Hassan Waseem, Zain ul Abideen, Areeba Shoaib , Sania Aimen, Justin Chen, Jamir Pitton Rissardo, Brandon Lucke-Wold
Conference: 2025 CNS Annual Meeting, Los Angeles, CA
Introduction
Spontaneous supratentorial intracerebral hemorrhage (SSICH) poses serious risks of complications and death. Various surgical techniques have been used, but their effectiveness remains unclear.
Objective
This network meta-analysis aims to compare the efficacy and safety of various surgical interventions used in SSICH and to rank them.
Methods
Databases including PubMed, Cochrane Central, and ScienceDirect were searched from inception till February 2025 for Randomized controlled trials (RCTs) investigating neuroendoscopy (NE), stereotactic aspiration (SA), craniopuncture surgery (CP), craniotomy (CR), decompressive craniectomy (DC), and conservative medical treatment (CMT). A frequentist network meta-analysis was conducted using R version 4.2.1 and the “netmeta” package, employing the random effects model. Treatment ranking was performed using p-scores, and the risk of bias was assessed using the ROB 2.0 tool. Publication bias was evaluated via funnel plots and Egger’s Regression test.
Results
The analysis included 25 RCTs with a total of 4,324 patients. Compared to CMT, NE demonstrated a significant improvement in good functional outcome (GFO) with an RR of 1.77 (95% CI: [1.43,2.20]; p<0.0001), while SA (RR=1.65, 95% CI: [1.38,1.98]; p<0.0001) and CR (RR=1.26, 95% CI: [1.04,1.54]; p=0.019) also showed marked improvements. NE was ranked highest for functional improvement, receiving a p-score of 0.93. Additionally, mortality rates were significantly lower for NE (RR=0.67, 95% CI: [0.52,0.85]; p=0.001) and CR (RR=0.82, 95% CI: [0.69,0.98]; p=0.028) compared to CMT. NE was identified as the most effective treatment for mortality reduction with a p-score of 0.81. The risk of rebleeding and overall complications with various surgical interventions was not significantly different compared to CMT
Conclusions
NE, SA, and CR notably enhanced functional outcomes, while NE and CR decreased mortality in patients with SSICH compared to CMT. Based on treatment ranking, NE was the most effective treatment for improving both functional scores and mortality.
Citation
Waseem MH, Abideen Z, Shoaib A, Aimen S, Chen J, Pitton Rissardo J, Lucke-Wold B. Comparing Various Surgical Interventions Versus Conservative Medical Treatment In Spontaneous Supratentorial Intracerebral Hemorrhage: A Network Meta-Analysis Of The Randomized Controlled Trials. CNS Annual Meeting 2025;2025:172. https://www.cns.org/poster-search?id=172
Figure. Forest plots comparing treatments for good functional outcome, mortality, rebleeding, and overall complications using random-effects models with relative risk and 95% confidence intervals.
Figure. Network diagrams showing direct and indirect comparisons among surgical and conservative treatments for four outcomes: functional recovery, mortality, rebleeding, and complications.
Figure. League tables presenting pairwise relative risks and confidence intervals for all interventions across functional outcome, mortality, rebleeding, and complication rates.