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(Stroke. 2009;40:e624.)
© 2009 American Heart Association, Inc.

Cochrane Corner

Surgery for Primary Supratentorial Intracerebral Hematoma

A Meta-Analysis of 10 Randomized Controlled Trials

From the Department of Neurology (K.P.), All India Institute of Medical Sciences, New Delhi, India; and the Department of Neurosurgery (A.D.M., B.G.), Newcastle General Hospital, Newcastle-upon-Tyne, UK.

Correspondence to Dr Kameshwar Prasad, Professor, Department of Neurology, Room No. 704, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail kprasad154@gmail.com

Graeme J. Hankey MD, FRCP Section Editor:

Key Words: intracranial hemorrhage • meta-analysis • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
There is considerable international variation in the rate and indications of surgery for primary supratentorial intracerebral hematoma (PSIH),^1,2 reflecting the uncertainty about the effects of surgery. Recently, some large randomized trials have appeared in the literature, but the controversy over its role continues.^3,4 This systematic review aims to evaluate randomized evidence to assess the effects of surgery plus routine medical management, compared with routine medical management alone, in patients with PSIH.

	Methods

 
We searched the Cochrane Stroke Group Trials Register (up to June 2007), monographs, and reference lists of relevant articles and contacted authors of relevant trials. Studies were eligible for inclusion if they were randomized trials of routine medical management plus intracranianl surgery (includes craniotomy, stereotactic, or endoscopic evacuation) compared with routine medical management alone in patients with CT-confirmed PSIH. Two review authors independently applied the inclusion criteria, assessed trial quality, and extracted the data. We assessed heterogeneity using ² test and I². Meta-analysis was done using fixed effects model with odds ratio as effect measure. Primary and secondary outcomes were death or dependence (Barthel Index of 60 or less) and death, respectively.

	Results

 
Ten trials with 2059 participants were included. The quality of most of the trials was acceptable but not high. Surgery was associated with statistically significant reduction in the odds of being dead or dependent at final follow up (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.58 to 0.88; 2P=0.001; Figure 1) with no significant heterogeneity (P=0.22; I²=24.7%) among the study . . . [Full Text of this Article]