title: Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  A wealth of evidence based on the randomized controlled trials (RCTs) has indicated that surgery may be a better choice in the management of primary intracerebral hemorrhage (ICH) compared to conservative treatment. However, there is considerable controversy over selecting appropriate surgical procedures for ICH. Thus, this meta-analysis was performed to assess the effects of stereotactic aspiration compared to craniotomy in patients with ICH.
  
  
  METHODS
  According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials. Other sources such as the internet-based clinical trial registries, relevant journals and the lists of references were also searched. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included death or dependence, total risk of complication, and the risk of rebleeding, gastrointestinal hemorrhage and systematic infection.
  
  
  RESULTS
  Four RCTs with 2996 participants were included. The quality of the included trials was acceptable. Stereotactic aspiration significantly decreased the odds of death or dependence at the final follow-up (odds ratio (OR): 0.80, 95% confidence interval (CI): 0.69-0.93; P = 0.004) and the risk of intracerebral rebleeding (OR: 0.44, 95% CI: 0.26-0.74; P = 0.002) compared to craniotomy with no significant heterogeneity among the study results.
  
  
  CONCLUSIONS
  The present meta-analysis provides evidence that the stereotactic aspiration may be associated with a reduction in the odds of being dead or dependent in primary ICH, which should be interpreted with caution. Further trials are needed to identify those patients most likely to benefit from the stereotactic aspiration.
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Jia-Wei
authors.initials: JW
authors.lastname: Wang
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Jin-Ping
authors.initials: JP
authors.lastname: Li
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Ying-Lun
authors.initials: YL
authors.lastname: Song
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Ke
authors.initials: K
authors.lastname: Tan
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Peng
authors.initials: P
authors.lastname: Guo
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Xiong
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Qi-Huang
authors.initials: QH
authors.lastname: Zhao
mesh_terms: D002543:Cerebral Hemorrhage / Q000601:surgery*; D003399:Craniotomy; D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013238:Stereotaxic Techniques