Journal of Central Nervous System Disease (Oct 2024)

Decompressive craniectomy versus craniotomy for acute subdural hematoma: A systematic review and meta-analysis with an adjusted subgroup analysis

  • Syed Hasham Ali,
  • Zoaib Habib Tharwani,
  • Asad Ali Siddiqui,
  • Fizza Iqbal,
  • Mahnoor Sadiq,
  • Ali Abdullah,
  • Abdullah Khalid,
  • Huzaifa Ul Haq Ansari,
  • Muhammad Usman,
  • Shurjeel Uddin Qazi,
  • Uzair Munaf,
  • Ibtehaj Ul Haque,
  • Shayan Marsia

DOI
https://doi.org/10.1177/11795735241297250
Journal volume & issue
Vol. 16

Abstract

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Introduction Acute subdural hematomas are major causes of morbidity which warrant immediate treatment. If surgical intervention is warranted, craniotomy (CO) and decompressive craniectomy (DC) are employed, largely based on a loosely defined criteria and the neurosurgeon’s best judgment. The primacy of one approach over another is a matter of dispute. Objective We attempt to further clarify any advantages in the two techniques, and include a propensity score matched (PSM) subgroup analysis to eliminate bias. Design This meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Data Sources and Methods A literature review was conducted on PubMed/Medline, Cochrane Central, and Google Scholar from inception to September 2023. 15 studies were extracted, and three outcomes were meta-analyzed: Mortality, Glasgow Outcome Scale (GOS) scores and patients undergoing re-operations/revisions. Odds Ratios (OR) and Mean Difference (MD) were used in dichotomous and continuous variables respectively. PSM data was used wherever possible. A subgroup analysis was conducted with 5 PSM studies and a trial. Heterogeneity was addressed if above 40% and the P -value is significant (≤ .05). Results A total of 15 studies were meta-analyzed with a total of 2327 and 2171 patients undergoing CO and DC respectively. Patients undergoing DC had a significantly worse GOS 5 outcome (OR: .63 [95% CI: .45-.87]; P = .005; I2 = 0%) and higher mortality (OR: 1.58 [95% CI: 1.20-2.08]; P = .001; I2 = 67%). In subgroup analysis of adjusted studies, DC still had significantly higher mortality. (OR: 1.50 [95% CI: 1.03-2.18]; P = .001; I2 = 83%). Conclusions This meta-analysis determines that CO is more viable than DC as a surgical option due to its less invasive nature. DC can be employed, albeit under strict preprocedural patient selection and for highly specific indications.