Surgery for Primary Intracerebral Hemorrhage: Meta-analysis of CT-Era Studies

To the Editor: I read with interest Hankey and Hon’s recent review of studies of surgery for primary intracerebral hemorrhage.1 Their systematic review of case series is a novel contribution to the literature. There is some precedent, however, for their meta-analysis of extant randomized controlled trials of surgical versus medical therapy. The authors may have been unaware of my brief meta-analysis of the same 4 trials, published 3 years earlier, as it appeared in a book chapter rather than a Medline article.2 Contrasts between the two meta-analyses are illuminating.My formal systematic overview examined the clinical end point of mortality rather than the combined clinical end point of death or dependency used by Hankey and Hon. Collating all 4 studies, I found no major effect of surgery, with an odds ratio of fatal outcome of 0.97 (95% confidence interval [CI], 0.64 to 1.48). This finding is similar that of Hankey and Hon for the combined death or dependency …