Meta Analysis
Endoscopic surgery versus microsurgery in treating hypertensive basal ganglia hemorrhage: A meta-analysis
Jin Panpan, Chen Jincao, Luo Jie, Cao Changjun, Wang Wei, Chen Bo, Tu Shengxu, Guo Yongchun
Published 2016-11-28
Cite as Chin J Neurosurg, 2016,32(11): 1162-1168. DOI: 10.3760/cma.j.issn.1001-2346.2016.11.021
Abstract
ObjectiveTo compare the clinical efficacy of neuroendoscopy and microsurgery for the treatment of hypertensive basal ganglia hemorrhage.
MethodsPubMed, Cochrane Library, Embase, VIP, CNKI, CBM and Wanfang database were retrieved. The randomized controlled trials and semi-randomized controlled trials comparing all the basal ganglia hemorrhage treated with neuroendoscopy and microsurgery were searched. The retrieval time was from the establishment of the database to October 31, 2015. After the detected literature being screened, extracted and evaluated, a Meta-analysis was performed using RevMan 5.3 software, and the GRADE system was used to conduct the quality evaluation of evidence.
ResultsFinally, A total of 9 trials with 700 patients were enrolled. The results of Meta-analysis showed: (1) in the aspect of safety: compared with the microscope group, the hematoma clearance rate was higher (SMD=0.63, 95% CI 0.30-0.95, P<0.001), operation time was shorter (SMD= -2.66, 95% CI -3.71- -1.60, P<0.001), hospitalization time was shorter (SMD=-0.72, 95% CI -1.01- -0.44, P<0.001), and postoperative complications were less (RR=0.56, 95% CI 0.40-0.77, P<0.001) of the neuroendoscopy group. There were no significant differences in the intraoperative bleeding and hospital cost between the 2 groups (all P<0.05). (2) In the aspect of effectiveness: compared with the microsurgery group, the prognosis was better (RR=1.15, 95% CI 1.03-1.27; P=0.002) and the mortality was lower (RR=0.57, 95% CI 0.22-1.00; P=0.05) in the neuroendoscope group.
ConclusionsCompared with the microsurgery, the prognosis of neuroendoscopy is better, the mortality is lower, the efficacy is better, and the surgical removal rate of the latter is higher, the operation time is shorter, the postoperative complications are less, and the safety is higher. But because of the quality of the original research is lower, the prudent choice and use in clinical practice ARE recommended. More high quality, large sample randomized controlled trials are needed for further argument.
Key words:
Intracranial hemorrhage, hypertensive; Neuroendoscopy; Microsurgery; Treatment outcome; Meta-analysis
Contributor Information
Jin Panpan
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
Chen Jincao
Luo Jie
Cao Changjun
Wang Wei
Chen Bo
Tu Shengxu
Guo Yongchun
