MINIMALLY INVASIVE SURGERY VERSUS CONVENTIONAL CRANIOTOMY FOR SPONTANEOUS INTRACEREBRAL HEMORRHAGE: AN UPDATED SYSTEMATIC REVIEW OF FUNCTIONAL OUTCOMES AND MODIFIERS OF SURGICAL EFFECT

Abstract

Objective: To compare the efficacy and safety of minimally invasive surgery (MIS) with conventional craniotomy for spontaneous supratentorial intracerebral hemorrhage (ICH) and identify modifiers of surgical effect. Methods: A systematic review structured according to PRISMA 2020, using a PICO framework of adults with spontaneous supratentorial ICH, MIS as the intervention, craniotomy as the main comparator, and functional and perioperative outcomes. Searches must be executed and documented in PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL, followed by independent study selection, standardized data extraction, and RoB 2 assessment. Results: Direct randomized evidence and the most recent published meta-analysis suggest a higher probability of favorable functional outcome with MIS, shorter operative time, and lower blood loss for selected modalities, without unequivocal differences in mortality or rebleeding. MISICH further supports endoscopy and stereotactic aspiration over craniotomy, particularly for deep hemorrhages. Conclusion: MIS may offer relevant advantages in selected patients, but technique, location, residual volume, timing, and patient selection modify outcomes. EDITORIAL NOTE: the final search date, PRISMA study counts, and formal risk-of-bias results must be inserted after these procedures are actually completed.