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Original research
Efficacy and safety of four interventions for spontaneous supratentorial intracerebral hemorrhage: a network meta-analysis
  1. Guangyu Guo,
  2. Chao Pan,
  3. Wenliang Guo,
  4. Shuang Bai,
  5. Hao Nie,
  6. Yangyang Feng,
  7. Gaigai Li,
  8. Hong Deng,
  9. Yang Ma,
  10. Suiqiang Zhu,
  11. Zhouping Tang
  1. Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  1. Correspondence to Dr Zhouping Tang, Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China; ddjtzp{at}; Professor Suiqiang Zhu; zhusuiqiang{at}


Object To investigate the efficacy and safety of four interventions of spontaneous intracerebral hemorrhage simultaneously.

Methods PubMed, EmBase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) investigating endoscopic surgery (ES), minimally invasive puncture surgery (MIPS), conventional craniotomy (CC), and/or conservative medical treatment (CMT). Good functional outcome, death, and hemorrhage recurrence rates were evaluated by a network meta-analysis.

Results 20 RCTs with 3603 patients were included. Compared with CMT, a higher rate of good functional outcome was found after ES (RR=2.21, 95% CI 1.37 to 3.55) and MIPS (RR=1.47, 95% CI 1.24 to 1.73). Both ES (RR=0.62, 95% CI 0.44 to 0.86) and MIPS (RR=0.72, 95% CI 0.58 to 0.90) markedly reduced the rate of death. However, there was no significant difference in efficacy and safety between ES and MIPS. The top ranked P score for the efficacy outcome was for ES (P score=0.9810). ES (P-score=0.0709) ranked lowest for the primary safety outcome. There was a higher risk of hemorrhage recurrence after CC (RR=3.80, 95% CI 1.90 to 7.63) and MIPS (RR=2.86, 95% CI 1.70 to 4.82) compared with CMT whereas no significant difference was found for ES (RR=1.46, 95% CI 0.53 to 4.02).

Conclusions The results suggest that both ES and MIPS significantly improve neurological function and reduce the risk of death compared with CMT, and there is no significant difference between ES and MIPS. Ranking of P scores revealed that ES may be the most optimal intervention to improve functional outcome and prevent death. This needs to be evaluated further.

  • Stroke
  • hemorrhage
  • intervention

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  • GG and CP contributed equally.

  • Contributors GG and CP performed the research and wrote the paper. WG and YM screened out relevant literature based on the search strategy. HN and YF retrieved and selected studies based on inclusion and exclusion criteria. GL and HD extracted and analyzed the data. YM analyzed and interpreted the data. ZT and SZ conceived the research study and made revisions to the manuscript. All authors have read and approved the final version of the manuscript.

  • Funding This work was supported by the National Natural Science Foundation of China (item No 81873750) and the Frontier Special Project of Applied Foundation of Wuhan Science and Technology Bureau (item No 2018060401011316).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.