Stereotactic Drainage Treatment is Associated with Improved Long-Term Neurological Recovery in Small-to-Moderate Volume Basal Ganglia Hemorrhages: A Systematic Review and Meta-Analysis

Background: The optimal management of small-to-moderate volume (≤ 50 mL) basal ganglia spontaneous intracerebral hemorrhage (ICH) is controversial. This meta-analysis aimed to compare the efficacy and safety of stereotactic drainage treatment (SDT) with conservative medical treatment (CMT) in this patient population. Methods: We queried major databases up to October 2025 for studies comparing SDT versus CMT for basal ganglia ICH ≤ 50 mL. The primary endpoint was good functional recovery (modified Rankin Scale score 0–2). Subgroup analyses were performed on the basis of cohort-mean hematoma volume (< 25 mL vs. 25–50 mL) and follow-up duration. Results: Eleven studies involving 1634 participants were analyzed. Compared with CMT, SDT was associated with a higher proportion of favorable functional outcome up to 12 months (P < 0.001). Subgroup analysis showed consistent functional benefits across both volume strata (< 25 mL and 25–50 mL), with significant superiority emerging from 3 months onwards (all P < 0.001). Mortality did not differ significantly between groups (P = 0.05). SDT also accelerated hematoma resolution and reduced hospital stay (all P < 0.05) without increasing infection (P = 0.17) or rebleeding risks (P = 0.19). Conclusions: SDT was associated with improved long-term functional recovery compared with CMT in cohorts with small-to-moderate basal ganglia ICH. Safety outcomes showed no statistically significant differences between groups. Large, multicenter randomized trials with standardized protocols are needed to confirm SDT’s efficacy and safety and to refine patient selection. © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2026.