There Is Still Hope for Surgery for Spontaneous Supratentorial Intracerebral Hemorrhage

See related article, p 1496.The epidemiological perspective on spontaneous intracerebral hemorrhage (ICH) is bleak. ICH affects approximately 1.5 million adults in the world each year, the incidence of ICH has not consistently changed over several decades, approximately 40% of patients still die within 1 month of ICH, and no specific treatment improves outcome.1,2 Unless effective treatments are found, the burden of ICH is certain to worsen given the recent rise in the incidence of stroke in low- to middle-income countries3 as well as the World Health Organization's estimate that the global population aged ≥60 years will more than triple from 600 million to 2 billion in 2050 (with most of this increase occurring in less developed countries).However, hope is offered by Gregson et al's4 individual patient data meta-analysis of randomized controlled trials of surgery for supratentorial ICH. This meta-analysis extends the work of the 2009 systematic review in the Cochrane Database5 by using data on 2186 individual patients in 8 randomized controlled trials to analyze the effects of surgery according to characteristics of the patient or their ICH. The advantage of individual patient data meta-analysis is that it increases the power to detect differential treatment effects across individuals …