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This Bayesian network meta-analysis compared conservative management with decompressive craniectomy, conventional craniotomy, endoscopic surgery and minimally invasive puncture surgery across 18 RCTs involving 4,497 patients. For good functional outcome at six months, minimally invasive puncture surgery (SUCRA 87.0%) and endoscopic surgery (84.6%) ranked highest and were superior to conventional craniotomy and conservative management. Decompressive craniectomy ranked highest for six-month mortality (SUCRA 81.5%), although most pairwise comparisons were not statistically significant. Endoscopic and minimally invasive approaches reduced operative time and blood loss versus craniotomy. Conclusion: Minimally invasive and endoscopic techniques may improve functional outcomes and reduce perioperative burden, but further high-quality trials are needed to establish optimal patient selection.
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This Bayesian network meta-analysis compared conservative management with decompressive craniectomy, conventional craniotomy, endoscopic surgery and minimally invasive puncture surgery across 18 RCTs involving 4,497 patients. For good functional outcome at six months, minimally invasive puncture surgery (SUCRA 87.0%) and endoscopic surgery (84.6%) ranked highest and were superior to conventional craniotomy and conservative management. Decompressive craniectomy ranked highest for six-month mortality (SUCRA 81.5%), although most pairwise comparisons were not statistically significant. Endoscopic and minimally invasive approaches reduced operative time and blood loss versus craniotomy. Conclusion: Minimally invasive and endoscopic techniques may improve functional outcomes and reduce perioperative burden, but further high-quality trials are needed to establish optimal patient selection.
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