Comparison of Decompressive Craniectomy Versus Craniotomy for Evacuation of Subdural Hemorrhage: A Systematic Review and Meta-Analysis

• Published in: The Journal of surgical research 2024-10, Vol.302, p.593-605
• Main Authors: Khan, Muhammad Hammad, Fatima, Maurish, Abid, Syeda Fatima, Faisal, Hashim, Ahmed, Roshaan, Rashid, Abdul Hannan, Amir, Saim, Kashif, Talha Bin, Syeda, Amna Zubia, Naqi, Syed Asghar
• Format: Article
• Language: English
• Subjects: Acute subdural hemorrhage; Brain Injuries, Traumatic - surgery; Craniotomy; Craniotomy - methods; Decompressive craniectomy; Decompressive Craniectomy - methods; Decompressive Craniectomy - statistics & numerical data; Glasgow Outcome Scale; Hematoma, Subdural, Acute - surgery; Humans; Meta-analysis; Randomized Controlled Trials as Topic; Treatment Outcome
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.07.107

Acute subdural hemorrhage (ASDH) from traumatic brain injury is a life-threatening situation, often requiring surgical intervention. This meta-analysis is done to update the literature regarding the choice of procedure for the treatment of ASDH. PubMed, Scopus, and Cochrane were searched from the year 2000 up to September 2023. Randomized controlled trials and observational studies were included. The odds ratio with 95% confidence interval (CI) mean difference and standardized mean difference were calculated for dichotomous and continuous outcomes, respectively. A total of 14 studies comprising 4686 patients were included in the analysis. Pooled Glasgow Outcome Scale/Extended Glasgow Outcome Scale scores were compared based on their means, with the craniotomy (CO) group having better mean scores than decompressive craniectomy (DC) (standardized mean difference −0.37, 95% CI −0.68 to −0.06, P = 0.02). The risk for poor outcomes was statistically greater in the DC group compared to the CO group (1.32, 95% CI 1.05-1.66, P value = 0.02). There were fewer residual subdural hematoma cases in the DC group as compared to CO (odds ratio 0.40, 95% CI 0.22-0.73, P value < 0.005). Our meta-analysis showed that the ASDH patients had better functional outcomes when treated with CO as compared to DC. However, there were fewer odds of residual subdural hematoma with DC. •Our meta-analysis comprising 4686 patients showed that patients undergoing craniotomy for the treatment of acute subdural hemorrhage had better functional outcomes as compared to decompressive craniectomy.•Additionally, there was a significantly reduced risk for residual subdural hematoma in the decompressive craniectomy group compared to craniotomy.•There was no significant difference in the risk of reoperation between the two groups.