Traditional craniotomy versus current minimally invasive surgery for spontaneous supratentorial intracerebral haemorrhage: a propensity-matched analysis

Abstract

Abstract Background Minimally invasive surgery (MIS) and craniotomy are the current treatments for spontaneous supratentorial cerebral haemorrhage (SSTICH). In this study, we aimed to compare the efficacy and safety of MIS and craniotomy for the treatment of SSTICH. Methods Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or craniotomy between January 2017 and December 2022 were retrospectively analysed. The patients were divided into two subgroups: the MIS group (MI) and craniotomy group (CI). Propensity score matching was performed to minimise case selection bias. The primary outcome was a dichotomous prognostic (favourable or unfavourable) outcome based on the modified Rankin Scale (mRS) scores at 3 months; an mRS score of 0–2 was considered favourable. Results In both conventional statistical and binary logistic regression analyses, the MI group had a better outcome. The outcome of propensity score matching was unexpected (odds ratio = 0.582; 95% confidence interval = 0.281–1.204; P = 0.144), which indicated that after excluding the interference of each confounder, different surgical modalities were more effective, and there was no significant difference in their prognosis. Conclusions The decision to choose MIS or craniotomy should be made based on the individual patient, considering the hematoma size, the degree of midline shift, cerebral swelling, and the preoperative Glasgow Coma Scale score.