Craniotomy versus endoscopic approach in basal ganglia haemorrhage: A systematic review and meta-analysis

Objectives: Basal ganglia haemorrhage (BGH) is the most common type of intracerebral bleed with high morbidity and mortality rate. Despite advancements in minimally invasive techniques in recent years, the efficacy between craniotomy and endoscopic approach for BGH is still debatable. The aim of this systematic review and meta-analysis was to evaluate the outcomes of craniotomy and endoscopic approach for BGH. Methods: Databases of Pubmed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until December 2020. All randomized clinical trials and observational studies comparing craniotomy versus endoscopic approach in BGH were included. Results: Twelve studies enrolling 1,297 patients (craniotomy:675, endoscopy:632) were included for qualitative and quantitative analysis. Endoscopic approach was associated with significantly lower postoperative mortality (OR:0.35, P<0.001), higher haematoma evacuation rate (MD:4.95, P<0.001), shorter operative time (MD:-117.03, P<0.001), lower intraoperative blood loss (MD:-328.47, P<0.001), higher postoperative Glasgow Coma Scale (GCS) (MD:1.14, P=0.01), higher postoperative Glasgow Outcome Scale (GOS) (MD:0.44, P=0.05), shorter length of hospital stay (MD:-2.90, P<0.001), lower complication rate (OR:0.30, P=0.001), lower infection rate (OR:0.29, P<0.001) and lower modified Rankin Scale (mRS) (MD:-0.57, P=0.004) compared to craniotomy. No significant difference was detected in re-operation, and re-bleeding. Conclusion: The best available evidence suggest that endoscopic approach has better outcomes in mortality rate, operative time, haematoma evacuation rate, intraoperative blood loss, length of hospital stay, mRS, postoperative GCS and GOS compared with craniotomy in the management of BGH. However, there is a need for high quality randomised controlled trials with large sample size for definitive conclusions.