Claire Creutzfeldt, MD; David Tirschwell, MD, MSc
In patients with primary supratentorial intracerebral hemorrhage, does early intracranial surgery plus routine medical treatment improve outcomes more than initial medical treatment alone?
Included studies compared early intracranial surgery (craniotomy, endoscopic evacuation, or stereotactic aspiration) plus routine medical management with initial medical management alone in patients with primary supratentorial intracerebral hematoma. Outcomes were death and a composite of death or dependence in activities of daily living.
Cochrane Stroke Group Trials Register (Jun 2007) and references were searched for randomized controlled trials (RCTs). 10 RCTs (n = 2059, mean age 57 to 69 y, 56% to 60% men) met the selection criteria. 7 trials reported adequate concealment of allocation, and 2 trials had blinded outcome assessment. Surgery occurred within 24 hours of symptom onset in most cases. Duration of follow-up was 3 months in 2 trials and 6 months in 8 trials. ≥ 8 trials provided data allowing for intention-to-treat analysis.
Early surgery reduced risk for death and the composite endpoint of death or dependence (Table). Treatment effect did not differ by surgical technique (P for interaction 0.67) (Table).
In patients with primary supratentorial intracerebral hemorrhage, early intracranial surgery improves outcomes more than initial medical treatment alone.
Early intracranial surgery plus medical treatment vs initial medical treatment alone for primary supratentorial intracerebral hemorrhage*
*ADL = activities of daily living; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using a fixed-effect model.
†Statistically significant heterogeneity of treatment effect was present.
Claire Creutzfeldt, David Tirschwell. Review: Early surgery improves outcomes in patients with primary supratentorial intracerebral hemorrhage. Ann Intern Med. 2009;150:JC4–10. doi: 10.7326/0003-4819-150-8-200904210-02010
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Published: Ann Intern Med. 2009;150(8):JC4-10.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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