#VisualAbstract: Association of Surgical Hematoma Evacuation vs Conservative Treatment With Functional Outcome in Patients With Cerebellar Intracerebral Hemorrhage

1. In this meta-analysis, the proportion of patients with cerebellar intracerebral hemorrhage who underwent surgical evacuation and had a favorable functional outcome was not greater than those who received conservative medical treatment.

2. The proportion of patients who survived at 3 months was significantly increased among patients who received surgical hematoma evacuation.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Current guidelines suggest surgical hematoma evacuation for cerebellar intracerebral hemorrhage (ICH) greater than 3cm for better functional outcomes. However, the evidence to support this claim is limited. In this systematic review and meta-analysis, surgical hematoma evacuations for found not lead to improved functional outcomes when compared to conservative medical treatment in patients with cerebellar ICH at 3 or 12 months post-ICH. However, surgical hematoma evacuation led to a higher proportion of patients who survived at 3 months.

This study has many limitations. This study included only retrospective cohort studies, and therefor has inherent limitations, such as lack of randomization and blinding. There is likely treatment bias which propensity matching cannot eliminate. The study’s ICH patients had mostly intermediate-sized hematomas, and optimal management for that sub-group of patients remains controversial.

Click to read the study in JAMA

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