Stroke: surgery had no clear effect on death or dependency in haemorrhage

Clinical bottom line (level 1a-)

  1. Patients with primary supratentorial intracerebral haemorrhage who were given endoscopic evacuation were less likely to die than those given no surgery.
  2. Patients who were given a craniotomy had no clear difference in death, than those given no surgery.
  3. Patients given endoscopic evacuation or craniotomy had no clear difference in death or dependency.
Prasad and Shrivastava: Surgery for primary supratentorial intracrerbral haemorrhage (Cochrane Review) 1999; 2: -
Expires December 2003

The study

Systematic review of unconfounded, randomised controlled trials of
  • Patients: primary supratentorial intracerebral haemorrhage
  • Intervention: surgery (craniotomy, stereotactic, endoscopic evacuation or stereotactic aspiration) plus routine medical treatment compared with routine medical treatment alone
  • Outcome: death or dependency


    • Articles found in ? language using Cochrane Stroke Group trials register, no dates given (search terms: not stated ) and Current Opinion in Neurology and Neurosurgery, and Neurosurgical Clinics of North America (1991 to July 1993), and searching reference lists.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: not randomised or patients with haematoma.

    Four trials involving 354 patients were included.

    The evidence

    • Three studies involved craniotomy. Odds of increased death with craniotomy was 43.0% (99% CI -176% to 26.0%). Odds of increased death or dependency was 99.0% (99% CI -331% to 8.00%).
    • One study involved endoscopic evacuation. Odds of reduced death with endoscopic evacuation was 69.0% (99% CI 10.0% to 89.0%). Odds of reduced death or dependency was 55.0% (99% CI -33.0% to 85.0%).

    Comments

    1. Only one trial involved endoscopic evacuation, so the data is not of a systematic review level of evidence.

    Citation

    1. Prasad K, and Shrivastava A: The Cochrane Library, Issue 2, Oxford: Update Software. Surgery for primary supratentorial intracrerbral haemorrhage (Cochrane Review) 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient intracerebral haemorrhagehemorrhage
    Intervention or Exposure surgery
    Comparison no surgery
    Outcome death or dependency