Objective Initial management strategies of chronic subdural hematoma (cSDH) are controversial, and range from bedside twist-drill or burr hole drainage, to craniotomy with membranectomy (CWM). We aim to (1) perform a meta-analysis of the available data on the outcomes of CWM for treatment of cSDH in published English-language literature, and (2) evaluate collective outcomes of CWM with respect to morbidity, mortality, and recurrence rates. Methods A search of English-language literature performed in PubMed, Ovid, and Cochrane databases using keywords (“subdural hematoma” or “chronic subdural hematoma”) and (“membrane” or “membranectomy”) from inception to December 2016 was conducted. Studies reporting outcomes of CWM in cSDH were included. Mortality, morbidity, follow-up duration, and recurrence rate data were extracted and analyzed. Pooled estimates and confidence-intervals (CIs) were calculated for all outcomes using a random-effects model. Results Of 301 articles found, 17 articles containing 5369 patients met our eligibility criteria. Mean follow-up duration ranged from 1–30.8 months. Collective mean mortality and morbidity rates were 3.7% and 6.9%, respectively (95% CI 2–5.4% and 2.1–11.6%; p<.001 and p=.004). The collective mean recurrence rate was 7.6% (95% CI: 5%–10.2%; p<.001). Conclusions Clinical data on outcomes of CWM in cSDH are limited to single institutional analyses, with considerable variation in recurrence rates and follow-up time. The rates we reported are comparable to the 5% mortality and 3–12% morbidity rates, and lower than the 10–21% recurrence rate in the literature for burr holes or craniotomy without membranectomy. This meta-analysis provides an in-depth analysis of available data and reviews reported outcomes.

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Background Baclofen is commonly used in both pediatric and adult patients to treat spasticity secondary to spinal cord and cerebral pathology. A broad range of symptoms and severity of baclofen toxicity have been described. However, to our knowledge, there are no reports to date of baclofen toxicity mimicking brain death in pediatric patients. Objective We reviewed the presentation, clinical course, diagnostic studies including imaging and electroencephalography, and outcome of a patient with transient coma and loss of brainstem reflexes mimicking brain death secondary to baclofen toxicity. Methods During a baclofen pump refill, a 12-year-old boy with cerebral palsy had inadvertent injection of 12,000 μg of baclofen into the pocket around his pump. Within an hour, he presented with acute altered mental status that rapidly progressed to a comatose state with absent brainstem reflexes. Results After appropriate management, the patient returned to his neurological baseline by hospital day 3. Discussion We reviewed the literature for varying presentations of baclofen toxicity and associated electroencephalography findings, mechanism of overdose, and different management options. In this case, the mechanism of baclofen toxicity was suspected to be secondary to extravasation from the pump pocket and subsequent systemic absorption. Conclusions Patients with baclofen toxicity may have a dramatic presentation and an initial examination mimicking brain death. Given its rarity, this clinical entity may not be readily recognized, and there is potential for misinterpretation of diagnosis and prognosis. It is important for physicians to be familiar with this clinical scenario to avoid false declaration of brain death.