A Cochrane review included 10 studies with a total of 2059 subjects with supratentorial intracerebral haemorrhage. Some trials used craniotomy, while others used stereotaxy and some trials used both; surgery was mostly done within 24 hours of onset. All trials excluded patients with aneurysm, arteriovenous malformation, trauma or tumour and most of them patients with any bleeding disorder. Average haematoma volume was between 37 ml to 66 ml and a Glasgow Coma Scale score of 4 to 15. The follow-up was 6 months in 8 trials and 3 months in 2 trials. Surgery was associated with reduction in the odds of being dead or dependent at final follow-up (OR 0.71, 95% CI 0.58 to 0.88). Surgery was also associated with significant reduction in the odds of death at final follow-up (OR 0.74, 95% CI 0.61 to 0.90).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions).