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

Background: Primary brainstem hemorrhage (PBSH) is a fatal condition related to hypertension. PBSH definitive treatment remains controversial, mainly when surgical options are discussed.

Objective: 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).

Methods: 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).

Results: 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.

Conclusion: SA demonstrated favorable outcomes, including reduced mortality rates and improved functional recovery. Further clinical trials are needed to validate these findings.