Neuroendoscopy Versus External Ventricular Drainage for Thalamic Hemorrhagic Stroke: A Systematic Review and Bayesian Meta‐Analysis

Background Neuroendoscopy and external ventricular drainage are commonly considered first‐line options for managing thalamic hemorrhage. However, their effectiveness in reducing the risk of rebleeding remains unclear. Aim To compare the efficacy and safety of neuroendoscopy versus external ventricular drainage through a systematic review and Bayesian meta‐analysis of randomized and nonrandomized studies. Methods We searched PubMed, Embase, and Cochrane for randomized and nonrandomized studies comparing neuroendoscopy with external ventricular drainage in patients with spontaneous thalamic hemorrhage. Data analysis was conducted using a Bayesian random‐effects model, with 95% credible intervals (CrI), estimating risk ratios for binary endpoints and mean differences for continuous endpoints. Results Six studies comprising 399 patients were included in the meta‐analysis. Although the pooled analysis showed no significant difference between groups in rebleeding risk (RR 0.61, 95% CrI 0.26–1.46; I 2 = 20.3%), neuroendoscopy was associated with an 87.4% posterior probability of reducing rebleeding risk compared with external ventricular drainage. Notably, neuroendoscopy significantly reduced the need for ventriculoperitoneal shunt (RR 0.48, 95% CrI 0.25–0.91; I 2 = 23.4%), with a 98.6% posterior probability of benefit. It was also associated with favorable prognosis (RR 1.42, 95% CrI 1.05–1.94, I 2 = 17%), with a 98.84% posterior probability of benefit. Conclusion In patients with thalamic hemorrhage, neuroendoscopy was associated with a higher probability of reducing both rebleeding risk and the need for ventriculoperitoneal shunt compared with external ventricular drainage.