Minimally Invasive Hematoma Evacuation for Acute Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review and Meta‐Analysis With Trial Sequential Analysis

@article{saleem2026minimally,
  title = {{Minimally Invasive Hematoma Evacuation for Acute Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review and Meta‐Analysis With Trial Sequential Analysis}},
  author = {Sahar Saleem and Zaryab Bacha and Khushal Khan and Khawaja Arham Jawaid and Muhammad Abbas and Shahab Iqbal and Umer Zaryab Khan and Muhammad Waqas and Saja Mohammed Taher Al‐Zamili and Humaira Obaid and Zuha Kashif and Abdullah Abdullah and Zahra Rehman and Javeria Javed and Kamil Ahmad Kamil},
  journal = {Brain and behavior},
  year = {2026},
  month = oct,
  doi = {10.1002/brb3.71815},
  url = {https://europepmc.org/article/PMC/PMC13662624},
  note = {CC BY},
}

TY  - JOUR
TI  - Minimally Invasive Hematoma Evacuation for Acute Spontaneous Supratentorial Intracerebral Hemorrhage: A Systematic Review and Meta‐Analysis With Trial Sequential Analysis
AU  - Sahar Saleem
AU  - Zaryab Bacha
AU  - Khushal Khan
AU  - Khawaja Arham Jawaid
AU  - Muhammad Abbas
AU  - Shahab Iqbal
AU  - Umer Zaryab Khan
AU  - Muhammad Waqas
AU  - Saja Mohammed Taher Al‐Zamili
AU  - Humaira Obaid
AU  - Zuha Kashif
AU  - Abdullah Abdullah
AU  - Zahra Rehman
AU  - Javeria Javed
AU  - Kamil Ahmad Kamil
PY  - 2026
DA  - 2026/10/01
JO  - Brain and behavior
DO  - 10.1002/brb3.71815
UR  - https://europepmc.org/article/PMC/PMC13662624
AB  - Background Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high morbidity and mortality. While surgical evacuation aims to reduce hematoma burden and improve outcomes, its clinical benefit over medical management remains uncertain. Previous systematic reviews have evaluated a broad range of surgical interventions for ICH; however, evidence specific to MIS remains less clearly defined. Therefore, we performed a systematic review and meta‐analysis to assess the efficacy and safety of minimally invasive hematoma evacuation in patients with acute spontaneous supratentorial ICH. Methods This meta‐analysis was performed in accordance with PRISMA 2020 guidelines and Cochrane recommendations. A comprehensive search of MEDLINE, Embase, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to February 2026. We included randomized controlled trials that compared minimally invasive hematoma evacuation with medical or conventional surgical management. Risk ratios (RR) and mean differences (MD) were pooled using a random‐effects model. Results A total of 12 RCTs involving over 2302 patients were included. Minimally invasive hematoma evacuation significantly reduced all‐cause mortality (RR = 0.77, 95% CI 0.61–0.97; p = 0.02) and 6‐month mortality (RR = 0.79, 95% CI 0.64–0.96; p = 0.02). No significant differences were observed in 7‐day or 30‐day mortality, although a trend favoring the intervention was noted. Functional outcomes, including mRS 0–1 and mRS 0–3, did not improve significantly. Among secondary outcomes, minimally invasive approaches were associated with greater hematoma volume reduction (MD = 62.47; p = 0.04) but also a higher risk of rebleeding (RR = 2.37; p = 0.002) and cardiac events (RR = 5.08; p = 0.009). No significant differences were found in ischemic stroke, renal failure, gastrointestinal bleeding, seizures, urinary tract infections, or length of hospital and ICU stay. Conclusions Minimally invasive hematoma evacuation significantly decreases mortality in patients with spontaneous ICH, especially with endoscopic techniques; however, it does not markedly enhance functional outcomes and may elevate the risk of complications such as rebleeding and cardiac events. These results underscore the necessity for meticulous patient selection and additional high‐caliber trials to enhance treatment strategies.
SN  - 2162-3279
ER  -