A comprehensive systematic review and meta-analysis study in comparing decompressive craniectomy versus craniotomy in patients with acute subdural hematoma

Abstract

There are two controversial surgery methods which are traditionally used: craniotomy and decompressive craniectomy. The aim of this study was to evaluate the efficacy and complications of DC versus craniotomy for surgical management in patients with acute subdural hemorrhage (SDH) following traumatic brain injury (TBI). We conducted a comprehensive search on PubMed, Scopus, Web of Science, and Embase up to July 30, 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Relevant articles were reviewed, with a focus on studies comparing decompressive craniectomy to craniotomy techniques in patients with SDH following TBI. Ten studies in 2401 patients were reviewed. A total of 1170 patients had a craniotomy, and 1231 had decompressive craniectomy. The mortality rate was not significantly different between the two groups (OR: 0.46 [95% CI: 0.42–0.5] P-value: 0.07). The rate of revision surgery was insignificantly different between the two groups (OR: 0.59 [95% CI: 0.49–0.69] P-value: 0.08). No significant difference was found between craniotomy and decompressive craniectomy regarding unilateral mydriasis (OR: 0.46 [95% CI: 0.35–0.57] P-value < 0.001). However, the craniotomy group had significantly lower rates of non-pupil reactivity (OR: 0.27 [95% CI: 0.17–0.41] P-value < 0.001) and bilateral mydriasis (OR: 0.59 [95% CI: 0.5–0.66] P-value: 0.04). There was also no significant difference in extracranial injury between the two groups, although the odds ratio of significant extracranial injury was lower in the craniotomy group (OR: 0.58 [95% CI: 0.45–0.7] P-value: 0.22). Our findings showed that non-pupil and bilateral-pupil reactivity were significantly more present in decompressive craniectomy. However, there was no significant difference between the two groups regarding mortality rate, extracranial injury, revision surgery, and one-pupil reactivity.

Investigating the Safety and Efficacy of Therapeutic Hypothermia in Pediatric Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis

“…The head size in newborns and infants is disproportionately large and the head-to-body ratio is higher than in adults. In addition, the calvarium in children is thinner rather than in adults, and open sutures and fontanelles at early ages allow for additional damage following ICP changes, which leads to more diffuse injuries than that of adults [ 38 , 39 ].…”

“…In addition, experimental studies have demonstrated that mild post-traumatic hypothermia reduces the levels of excitatory neurotransmitters, proinflammatory cytokines, and lactate accumulation. This reduction in temperature not only decreases the need for anaerobic metabolism by lowering oxygen consumption but also leads to a decrease in membrane permeability [ 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Consequently, the influx of ions, particularly Ca 2+ and Na + , is diminished, thereby reducing the cascade of events they initiate.…”

Assessment of cerebrovascular alterations induced by inflammatory response and oxidative–nitrative stress after traumatic intracranial hypertension and a potential mitigation strategy

“…Decompressive craniectomy (DC) is prone to severe intraoperative brain herniation, thereby decreasing the prognosis of such patients. Impairment of brainstem vasomotor centers as a result of angular acceleration is the most widely accepted theory for the mechanism of intraoperative brain herniation, highlighting the major role of cerebral arterial blood flow 5,6 . However, the microcirculation and venous system, which contain the highest blood volume in the brain, are also important.…”