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We searched MEDLINE, Embase, and Cochrane databases up to February 21, 2019. Primary outcome was good functional outcome at follow\u2010up; secondary outcomes were death and serious adverse events. We analyzed all types of surgery combined and minimally invasive approaches separately. We pooled risk ratios with 95% confidence intervals and assessed the modifying effect of age, Glasgow Coma Scale, hematoma volume, and timing of surgery with meta\u2010regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 21 studies with 4,145 patients; 4 (19%) were of the highest quality. Risk ratio of good functional outcome after any type of surgery was 1.40 (95% confidence interval [CI] =\u20091.22\u20131.60, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200946%, 20 studies), and after minimally invasive surgery it was 1.47 (95% CI\u2009=\u20091.26\u20131.72, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200947%, 12 studies). For death, the risk ratio for any type of surgery was 0.77 (95% CI\u2009=\u20090.68\u20130.85, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200923%, 21 studies), and for minimally invasive surgery it was 0.68 (95% CI\u2009=\u20090.56\u20130.83, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200914%, 13 studies). Serious adverse events were reported infrequently. Surgery seemed more effective when performed sooner after symptom onset (<jats:italic>p<\/jats:italic>\u2009=\u20090.04, 12 studies). Age, Glasgow Coma Scale, and hematoma volume did not modify the effect of surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Surgical treatment of supratentorial spontaneous ICH may be beneficial, in particular with minimally invasive procedures and when performed soon after symptom onset. Further well\u2010designed randomized trials are needed to demonstrate whether (minimally invasive) surgery improves functional outcome after ICH and to determine the optimal time window of the treatment after symptom onset. <jats:bold>ANN NEUROL 2020;88:239\u2013250.<\/jats:bold><\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.25732","type":"journal-article","created":{"date-parts":[[2020,4,2]],"date-time":"2020-04-02T10:41:58Z","timestamp":1585824118000},"page":"239-250","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":130,"title":["Neurosurgical Intervention for Supratentorial Intracerebral Hemorrhage"],"prefix":"10.1002","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2037-7484","authenticated-orcid":false,"given":"Lotte","family":"Sondag","sequence":"first","affiliation":[{"name":"Department of Neurology, Donders Institute for Brain, Cognition, and Behavior Radboud University Medical Center  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris H. B. M.","family":"Schreuder","sequence":"additional","affiliation":[{"name":"Department of Neurology, Donders Institute for Brain, Cognition, and Behavior Radboud University Medical Center  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hieronymus D.","family":"Boogaarts","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Radboud University Medical Center  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maroeska M.","family":"Rovers","sequence":"additional","affiliation":[{"name":"Departments of Operating Rooms and Health Evidence Radboud University Medical Center  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Peter","family":"Vandertop","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, VU University Medical Center  Amsterdam the Netherlands"},{"name":"Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Academic Medical Center  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Dammers","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Erasmus Medical Center, Erasmus MC Stroke Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8495-4578","authenticated-orcid":false,"given":"Catharina J. M.","family":"Klijn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Donders Institute for Brain, Cognition, and Behavior Radboud University Medical Center  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Dutch ICH Surgery Trial Study Group, part of the CONTRAST consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70025-0"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000441085"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70089-5"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70340-0"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.2413"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306476"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001564"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214609"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603460"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2016-314386"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31878-6"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","unstructured":"Parry\u2010JonesAR Sammut\u2010PowellC ParoutoglouK et al.An intracerebral hemorrhage care bundle is associated with lower case fatality.Ann Neurol2019;86:495\u2013503.","DOI":"10.1002\/ana.25546"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000069"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12309"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)70233-6"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60986-1"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.640284"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30195-3"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30253-9"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1582132"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002897"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000208408.98482.99"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.10.1294"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.09.121"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181fe7825"},{"key":"e_1_2_7_27_1","unstructured":"HigginsJPT Thomas J ChandlerJ et al. 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