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Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2016; 35(02): 118-127
DOI: 10.1055/s-0035-1571270
Original Article | Artigo Original
Thieme Publicações Ltda Rio de Janeiro, Brazil

Surgical Treatment of Chronic Subdural Hematoma: Systematic Review and Meta-Analysis of the Literature

Tratamento cirúrgico do hematoma subdural crônico: revisão sistemática e metanálise da literatura
Alisson R. Teles
1   Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
,
Asdrubal Falavigna
1   Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
,
Jorge Kraemer
2   Neurosurgery Unit, Hospital São José - Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
› Author Affiliations
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Publication History

24 September 2015

01 December 2015

Publication Date:
12 February 2016 (online)

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Abstract

Background There are many controversies in the literature on the treatment of chronic subdural hematoma (CSDH).

Objective To assess the effects of different surgical techniques and postoperative care on recurrence of CSDH.

Methods Systematic review through Medline search of articles published between January 1990 and July 2011. Controlled observational and randomized clinical trials (RCT) regarding surgical approach, irrigation, drainage, and postoperative patient position in patients with CSDH were included. The outcome was recurrence requiring reoperation. Independent extraction of articles was conducted by 2 authors using predefined data fields, including study risk of bias indicators.

Results 35 publications met inclusion criteria. Pooled analyses did not demonstrate difference in recurrence rates when compared burr-hole craniostomy (BHC) x twist-drill craniostomy (TDC) (OR: 0.99; CI95%: 0.53–1.84; p = 0.97), BHC x craniotomy (OR: 1.23; CI95%: 0.78–1.95; p = 0.36), nor TDC x craniotomy (OR: 16.11; CI95%: 0.85–306.88; p = 0.06). In patients receiving BHC, pooled analysis showed a lower recurrence rate in patients receiving 2BHC compared with 1BHC (OR: 0.58; CI95%: 0.37–0.88; p = 0.01). The use of drainage system after evacuation of CSDH by BHC reduces the recurrence (OR: 0.41; CI95%: 0.23–0.74; p = 0.003).There is not enough evidence to support either a specific location of the tip of drain, nor the postoperative patient position as factors influencing on recurrence.

Conclusion Well-designed studies are urgently needed to verify the effectiveness of most neurosurgical procedures routinely performed for CSDH.

Resumo

Introdução Existem inúmeras controvérsias na literatura sobre o tratamento do hematoma subdural crônico (HSDC).

Objetivo Avaliar os resultados das diferentes técnicas cirúrgicas e cuidados pós-operatórios na recidiva do HSDC.

Métodos Revisão sistemática de artigos publicados no Medline entre Janeiro de 1990 a Julho de 2011. Foram incluídos estudos observacionais controlados e ensaios clínicos randomizados (ECR) relacionados à abordagem cirúrgica, irrigação, uso de dreno e posicionamento no pós-operatório de pacientes com HSDC. O desfecho estudado foi recidivo necessitando reoperação. A extração dos dados foi conduzida de maneira independente por dois autores utilizando campos pré-definidos, incluíndo indicadores de viés dos estudos.

Resultados Trinta e cinco artigos foram incluídos na análise. A metanálise não demonstrou diferença nas taxas de recorrência quando comparadas às técnicas de trepanação burr-hole (BHC) X twist-drill (TDC) (OR: 0,99; IC95%: 0,53–1,84; p = 0,97), BHC X craniotomia (OR: 1,23; IC95%: 0,78–1,95; p = 0,36), nem TDC X craniotomia (OR: 16,11; IC95%: 0,85–306,88; p = 0.06). Em pacientes operados por BHC, a metanálise demonstrou menor taxa de recidiva em pacientes operados com 2BHC em comparação a 1BHC (OR: 0,58; IC95%: 0,37–0,88; p = 0,01). O uso de dreno no pós-operatório por BHC reduziu a recidiva (OR: 0,41; IC95%: 0,23–0,74; p = 0,003). Não há evidência suficiente que aponta do dreno ou a posição do paciente no pós-operatório tenham influência na chance de recidiva.

Conclusão Estudos bem delineados são necessários para comparar a efetividade da maioria dos procedimentos neurocirúrgicos realizados rotineiramente para HSDC.

Keywords

chronic subdural hematoma - treatment - surgery - recurrence - meta-analysis

Palavras-chave

hematoma subdural crônico - tratamento - cirurgia - recidiva - metanálise
 

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