Evidence map›Paper›PMID 40958054›Full record

Trial reportNeurocritical care2026

Impact of Minimally Invasive Surgery on Midline Shift and Outcomes in Large Supratentorial Spontaneous Intracerebral Hemorrhage: Post Hoc Analysis of MISTIE III.

Wendy C Ziai, Anusha Yarava, Joshua B Gruber, Yunke Li, Nathan Walborn, Nick Rizzutti, Meghan Hildreth, Issam Awad, Daniel F Hanley

Abstract readRandomized Controlled TrialClinical Trial, Phase III
PubMed Publisher
In one paragraph

Trial report in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Wendy C ZiaiDepartment of Neurology, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. weziai@jhmi.edu.ORCID 0000-0003-4548-7353
Anusha YaravaBIOS Clinical Trials Coordinating Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Joshua B GruberBIOS Clinical Trials Coordinating Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Yunke LiBIOS Clinical Trials Coordinating Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nathan WalbornBIOS Clinical Trials Coordinating Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nick RizzuttiBIOS Clinical Trials Coordinating Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Meghan HildrethBIOS Clinical Trials Coordinating Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Issam AwadDepartment of Neurosurgery, University of Chicago Medicine, Chicago, IL, USA.
Daniel F HanleyBIOS Clinical Trials Coordinating Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Funding

MISTIE III_ Lead Grant_ Cluster Application for the Clinical Coordinating CenterU01NS080824 · NINDS · JOHNS HOPKINS UNIVERSITY · PI HANLEY, DANIEL F · 2013 to 2017
$23.2M
NINDS NIH HHS U01NS080824
6 · The paper itself

Abstract

backgroundMinimally invasive surgery (MIS) for large supratentorial intracerebral hemorrhage (ICH) addresses primary brain injury by reducing mass effect, causing midline shift (MLS). We investigated the relationship between MIS, MLS, and functional outcomes in a large clinical trial.

methodsWe conducted a post hoc analysis of patients with qualified computed tomography (CT) images from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation trial. The exposure was MLS at the pineal gland (PG) and septum pellucidum (SP) on CT scans at diagnosis, end of treatment (EOT), and hospital discharge. The primary outcome was 30-day mortality. Secondary outcomes were mortality and modified Rankin scale score at day 365. We performed multivariable logistic regression and mediation analyses, adjusted for demographics, ICH characteristics, and treatment.

resultsParticipants had a median age of 62 years and a median ICH volume of 44 mL, and 61% were male. Thirty-day mortality was 12%. MLS on EOT CT was significantly lower in surgical patients compared with medical patients. EOT MLS in day 30 surgical survivors was also significantly lower compared with that in medically treated survivors and nonsurvivors. The odds of 30-day mortality on adjusted analyses were significantly increased by 1 mm in MLS at both the PG and SP (PG: odds ratio 1.22, 95% confidence interval 1.06-1.41; SP: odds ratio 1.22, 95% confidence interval 1.10-1.36). Thresholds of MLS change < 3 mm (SP) and < 5 mm (PG) were associated with mortality reduction. The association of MIS with 30-day mortality was mediated fully by change in either the SP or PG MLS from diagnostic to EOT CT. Change in MLS was significantly associated with one-year mortality and, for SP, with one-year good functional outcome (modified Rankin scale scores 0-3).

conclusionsMIS for ICH significantly reduces MLS. This reduction in MLS significantly mediates reduction in 30-day mortality with MIS and is associated with both short-term and long-term outcomes.

Indexed as

Cerebral HemorrhageMinimally Invasive Surgical ProceduresNeurosurgical ProceduresOutcome Assessment, Health CareAgedFemaleFibrinolytic AgentsHumansMaleMiddle AgedTissue Plasminogen ActivatorTomography, X-Ray ComputedFibrinolytic AgentsTissue Plasminogen ActivatorClinical neurologyImage analysisIntracerebral hemorrhageNeurosurgeryStroke

Identifiers

PMID40958054

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.