ReviewSurgical neurology international2026
Surgical management of intracerebral hemorrhage: A meta-analysis demonstrating improved functional outcome and survival with time-dependent functional benefit.
Review in Surgical neurology international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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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.
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Authors and funding
8 authors.
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Abstract
Background: The role of surgical evacuation in spontaneous intracerebral hemorrhage (ICH) remains controversial. Previous trials have yielded inconclusive results, and uncertainty persists regarding how hemorrhage location, hematoma volume, surgical technique, and timing of intervention influence functional outcomes and mortality. Methods: We conducted a systematic review and meta-analysis of 29 randomized controlled trials comprising 5,531 patients comparing surgical evacuation with conservative medical management. Primary outcomes were a favorable functional outcome (modified Rankin Scale ≤3 at final follow-up) and all-cause mortality. Prespecified subgroup analyses explored potential effect modification by timing of intervention, hemorrhage location, hematoma volume, and surgical technique. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Absolute effects and numbers needed to treat (NNT) were derived from pooled estimates using representative control event rates. Results: Surgical evacuation was associated with improved functional outcome (OR 1.31, 95% CI 1.17-1.46) and reduced all-cause mortality (OR 0.83, 95% CI 0.73-0.93) compared with conservative management. Using representative control event rates, the pooled ORs correspond to an estimated absolute increase in favorable functional outcome of approximately 6-7% (NNT ≈15; range 11-26) and an absolute mortality reduction of approximately 4-5% (NNT ≈21; range 13-55), depending on baseline risk assumptions. In subgroup analysis, surgery performed within 24 hours showed greater absolute clinical benefit, corresponding to an estimated NNT of approximately 10 for favorable functional outcome and 12 for mortality reduction. Subgroup analysis demonstrated a statistically significant interaction between timing and functional outcome ( Conclusion: Surgical evacuation in spontaneous ICH is associated with improved functional outcome and reduced mortality compared with conservative management. Greater functional benefit was observed with earlier intervention. No statistically significant effect modification was detected for anatomical location or surgical technique, and subgroup differences by hematoma volume should be interpreted cautiously. These findings support consideration of timely and individualized surgical management in appropriately selected patients.
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