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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0044-1791539
Review Article

Craniotomy versus Decompressive Craniectomy in Acute Subdural Hematoma Management: A Systematic Review and Meta-Analysis

Mohammed Maan Al-Salihi 
1   Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
,
Maryam Sabah Al-Jebur
2   College of Medicine, University of Baghdad, Baghdad, Iraq
,
Yezan Al-Salihi
2   College of Medicine, University of Baghdad, Baghdad, Iraq
,
Elias Dumour
3   Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS foundation Trust, Bristol, United Kingdom
,
Ahmed Saleh
4   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
,
Mhran Daie
4   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
,
Firas Hammadi
4   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
,
Ali Ayyad
4   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
5   Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
› Author Affiliations Funding None.
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Abstract

Background This study aimed to compare the clinical outcomes of decompressive craniectomy (DC) and craniotomy in treating acute subdural hematoma (ASDH) to provide a more precise assessment of the procedures' outcomes.

Methods We searched for relevant articles in PubMed, Web of Science, Embase, Scopus, and Cochrane till August 2023, including cohort studies and randomized controlled trials comparing craniotomy and DC for ASDH. The analysis was conducted using “Review Manager” software, using the risk ratio along with a 95% confidence interval (CI) for categorical data, whereas continuous data were analyzed using the mean difference (MD) and 95% CI.

Results Our analysis included 13 studies with a total of 4,689 patients, of whom 1,910 (40.7%) underwent DC and 2,779 (59.3%) underwent craniotomy. The results revealed a statistically significant difference in favor of craniotomy concerning good recovery in delayed GOS (risk ratio [RR] = 1.42; 95% CI [1.12, 1.81]), postoperative mortality (RR = 0.81; 95% CI [0.71, 0.94]), mortality at last follow-up (RR = 0.75; 95% CI [0.62, 0.91]), and hospital stay (MD = –3.71; 95%CI [–5.82, –1.60]). A nonsignificant difference (RR = 1.06; 95% CI [0.52, 2.17]; p = 0.87) was found between the two interventions concerning seizures.

Conclusion Despite craniotomy's favorable clinical outcomes and mortality rates, the significant baseline differences between DC and craniotomy make these data inconclusive. To establish solid evidence regarding the use of DC versus craniotomy in ASDH, it is necessary to conduct well-controlled randomized studies with large sample sizes.

Keywords

craniotomy - decompressive craniectomy - acute subdural hematoma - ASDH - meta-analysis

Supplementary Material



Publication History

Received: 05 March 2024

Accepted: 14 August 2024

Article published online:
08 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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