Comparison of Clinical Outcome between Craniectomy and Craniotomy as Surgical Management of Traumatic Acute Subdural Hematoma: A Systematic Review and Meta-analysis

Mahadewa, Tjokorda Gde Bagus; Mardhika, Putu Eka; Maliawan, Sri; Golden, Nyoman; Awyono, Steven; Ryalino, Christopher

doi:10.3889/oamjms.2020.4282

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…18 In a meta-analysis conducted by Mahadewa, et al in 2020, comparing GCS score between craniectomy and craniotomy in patients with traumatic acute subdural hematoma, revealed craniectomy had poorer clinical outcomes with a pooled risk ratio of 1.41 (95% CI: 1.06-1.88; p=0.02). 19 The opposite conclusion was put forward by Leghani, et al in 2013. Research by Legnani, et al involving 152 patients demonstrated that performing a suboccipital craniotomy has similar effectivity and safety compared to performing a craniectomy.…”

Section: Discussionmentioning

confidence: 92%

Comparison of Mortality and Glasgow Outcome Scale Extended (GOSE) between Craniotomy and Decompressive Craniectomy in Patients with Traumatic Acute Subdural Hematoma at Sanglah General Hospital, Bali

Yanti

Niryana

Maliawan

et al. 2022

JBN

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Background: Craniotomy and decompressive craniectomy and are surgical modalities for the evacuation of acute subdural hematoma (SDH). These two techniques show different outcomes in various existing studies. The superiority between either techniques remains controversial. Objective: To determine the outcome comparison of mortality and Glasgow Outcome Scale Extended (GOSE) craniotomy with decompressive craniectomy in patients with traumatic acute SDH. Methods: This is a historical cohort study. Samples of the study were collected from January 2018 to March 2020 at Sanglah General Hospital. All patients with acute traumatic SDH who underwent SDH evacuation with craniotomy and decompressive craniectomy were assessed for mortality status at discharge and GOSE 3 months after surgery. Independent T-test will be carried out if the numerical variable were all normally distributed, while Mann-Whitney U test will be performed if otherwise. A Chi-square test will be performed on all unpaired categorical variables. Statistical analysis was performed with SPSS 25 with 95% confidence intervals. Results: As many as 40 subjects with traumatic acute SDH who underwent craniotomy and 40 subjects with traumatic acute SDH who underwent decompressive craniectomy were included in this study. There was no significant difference in mortality (RR: 1; 95% CI 0.67-1.87; p=0.651) and GOSE score (p=0.718) in traumatic acute SDH who underwent craniotomy or decompressive craniectomy. Conclusion: There was no difference in mortality and GOSE outcomes between a craniotomy and decompressive craniectomy for management of traumatic acute SDH.

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Section: Discussionmentioning

confidence: 92%

Comparison of Mortality and Glasgow Outcome Scale Extended (GOSE) between Craniotomy and Decompressive Craniectomy in Patients with Traumatic Acute Subdural Hematoma at Sanglah General Hospital, Bali

Yanti

Niryana

Maliawan

et al. 2022

JBN

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

Al-Salihi,

Al-Jebur,

Al-Salihi

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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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.

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Comparison of craniotomy and decompressive craniectomy for acute subdural hematoma -a Meta-Analysis of comparative study

Li,

Yao,

Gan

et al. 2024

International Journal of Surgery

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Background: Acute subdural hematoma (ASDH) necessitates urgent surgical intervention. Craniotomy (CO) and decompressive craniectomy (DC) are the two main surgical procedures for ASDH evacuation. This meta-analysis is to compare the clinical outcomes between the CO and DC procedures. Materials and methods: The authors performed a meta-analysis according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA, Supplemental Digital Content 1, http://links.lww.com/JS9/C513, Supplemental Digital Content 2, http://links.lww.com/JS9/C514) Statement protocol and assessing the methodological quality of systematic reviews (AMSTAR) (Supplemental Digital Content 3, http://links.lww.com/JS9/C515) guideline. The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched. Comparative studies reporting the outcomes of the CO and DC procedures in patients with ASDH were included. Results: A total of 15 articles with 4853 patients [2531 (52.2%) receiving CO and 2322 (47.8%) receiving DC] were included in this meta-analysis. DC was associated with higher mortality [31.5 vs. 40.6%, odds ratio (OR)=0.58, 95% CI: 0.43–0.77] and rate of patients with poorer neurological outcomes (54.3 vs. 72.7%; OR=0.43, 95% CI: 0.28–0.67) compared to CO. The meta-regression model identified the comparability of preoperative severity as the only potential source of heterogeneity. When the preoperative severity was comparable between the two procedures, the mortality (CO 35.5 vs. DC 38.1%, OR=0.80, 95% CI: 0.62–1.02) and the proportion of patients with poorer neurological outcomes (CO 64.8 vs. DC 66.0%; OR=0.82, 95% CI: 0.57–1.16) were both similar. Reoperation rates were similar between the two procedures (CO 16.1 vs. DC 16.0%; OR=0.95, 95% CI: 0.61–1.48). Conclusion: Our meta-analysis reveals that DC is associated with higher mortality and poorer neurological outcomes in ASDH compared to CO. Notably, this difference in outcomes might be driven by baseline patient severity, as the significance of surgical choice diminishes after adjusting for this factor. Our findings challenge previous opinions regarding the superiority of CO over DC and underscore the importance of considering patient-specific characteristics when making surgical decisions. This insight offers guidance for surgeons in making decisions tailored to the specific conditions of their patients.

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Comparison of Clinical Outcome between Craniectomy and Craniotomy as Surgical Management of Traumatic Acute Subdural Hematoma: A Systematic Review and Meta-analysis

Cited by 3 publications

References 19 publications

Comparison of Mortality and Glasgow Outcome Scale Extended (GOSE) between Craniotomy and Decompressive Craniectomy in Patients with Traumatic Acute Subdural Hematoma at Sanglah General Hospital, Bali

Comparison of Mortality and Glasgow Outcome Scale Extended (GOSE) between Craniotomy and Decompressive Craniectomy in Patients with Traumatic Acute Subdural Hematoma at Sanglah General Hospital, Bali

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

Comparison of craniotomy and decompressive craniectomy for acute subdural hematoma -a Meta-Analysis of comparative study

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