Stereotactic aspiration versus conservative management for primary brainstem hemorrhage: A systematic review and meta-analysis

Primary brainstem hemorrhage (PBSH) is a fatal condition related to hypertension. PBSH definitive treatment remains controversial, mainly when surgical options are discussed. To aid decision-making in PBSH scenarios, we aimed to perform a meta-analysis and evaluate the literature on stereotactic asp...

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Published in:	Clinical neurology and neurosurgery Vol. 246; p. 108583
Main Authors:	Pustilnik, Hugo Nunes, Fontes, Jefferson Heber Marques, Porto Junior, Silvio, Punukollu, Anuraag, Sousa, Marcelo Porto, da Cunha, Beatriz Lopes Bernardo, Meira, Davi Amorim, Cerqueira, Gabriel Araújo, Medrado-Nunes, Gabriel Souza, Vassoler, Maria Eduarda Messias, da Silva da Paz, Matheus Gomes, Alcântara, Tancredo, de Avellar, Leonardo Miranda, Silva, Jackson Daniel Sousa
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-11-2024 Elsevier Limited
Subjects:	Brain stem Clinical trials Decision making Hematoma Hemorrhage Hemorrhagic stroke Hypertension Intracerebral hemorrhage Meta-analysis Mortality Patients Primary brainstem hemorrhage Recovery of function Stereotactic aspiration Systematic review Primary brainstem hemorrhage Hemorrhagic stroke Stereotactic aspiration Intracerebral hemorrhage
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Summary:	Primary brainstem hemorrhage (PBSH) is a fatal condition related to hypertension. PBSH definitive treatment remains controversial, mainly when surgical options are discussed. To aid decision-making in PBSH scenarios, we aimed to perform a meta-analysis and evaluate the literature on stereotactic aspiration (SA) for PBSH in comparison to conservative management (CM). The outcomes assessed were: 30-day mortality, mortality, 90-day good outcome (mRs ≤ 3), good outcome (mRs ≤ 3), good outcome (mRs ≤ 3 or GOS 4–5), 90-day poor outcome (mRs ≥ 4), poor outcome (mRs ≥ 4). We included 1189 patients from 9 studies. 433 (36,41 %) patients were treated with SA. The risk of 30-Day Mortality (RR 0.57; 95 % CI 0.41–0.81; p=0.002; I²=58 %), Mortality (RR 0.56; 95 % CI 0.41–0.75; p<0.001; I²=54 %), 90-Day Poor Outcome (mRS ≥ 4) (RR 0.83; 95 % CI 0.73–0.93; p=0.001; I²=25 %), Poor Outcome (mRS ≥ 4) (RR 0.83; 95 % CI 0.75–0.93; p=0.001; I²=0 %) and Poor Outcome (mRS ≥ 4 or GOS ≤ 3) (RR 0.82; 95 % CI 0.74–0.91; p<0.001; I²=12 %) were significantly lower in patients receiving SA treatment. Also, the risk of 90-Day Good Outcome (mRS ≤ 3) (RR 1.60; 95 % CI 1.06–2.39; p=0.024; I²=21 %), Good Outcome (mRS ≤ 3) (RR 1.48; 95 % CI 1.13–1.94; p=0.005; I²=0) and Good Outcome (mRS ≤ 3 or GOS 4–5) (RR 1.72; 95 % CI 1.17–2.53; p=0.006; I²=25 %) were significant higher in the SA group. SA demonstrated favorable outcomes, including reduced mortality rates and improved functional recovery. Further clinical trials are needed to validate these findings.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	0303-8467 1872-6968 1872-6968
DOI:	10.1016/j.clineuro.2024.108583