Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma

Hutchinson, Peter J.; Adams, Hadie; Mohan, Midhun; Devi, Bhagavatula Indira; Uff, Christopher; Hasan, Shumaila; Mee, Harry; Wilson, Mark; Gupta, Deepak; Bulters, Diederik; Zolnourian, Ardalan; McMahon, Catherine; Stovell, Matthew G; Al‐Tamimi, Yahia; Tewari, Manoj Kumar; Tripathi, Manjul; Thomson, Simon; Viaroli, Edoardo; Belli, Antonio; King, Andrew; Helmy, Adel; Timofeev, Ivan; Pyne, Sarah; Shukla, Dhaval; Bhat, Dhananjaya I; Maas, Andrew R; Servadei, Franco; Manley, Geoffrey T.; Barton, Garry; Turner, Carole; Menon, David K.; Gregson, Barbara; Kolias, Angelos G.

doi:10.1056/nejmoa2214172

Cited by 71 publications

(32 citation statements)

References 22 publications

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“…Consequently, they were assessed for eligibility and full-text screening, which led to the inclusion of 17 studies. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 The searching and screening process is shown in the flowchart ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Comparing surgical outcomes: Craniotomy versus decompressive craniectomy in acute subdural hematoma - A systematic review and meta-analysis

Nadeem,

Siddiqui,

Rais

et al. 2024

World Neurosurgery: X

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Section: Resultsmentioning

confidence: 99%

Comparing surgical outcomes: Craniotomy versus decompressive craniectomy in acute subdural hematoma - A systematic review and meta-analysis

Nadeem,

Siddiqui,

Rais

et al. 2024

World Neurosurgery: X

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“…Hutchinson et al [ 27 ] conducted a randomized clinical trial and investigated the disability and quality of life with the EuroQol Group 5-Dimension 5-Level questionnaire (EQ-5D-5L). The EQ-5D-5L scores at 12 months were comparable between the DC and craniotomy groups.…”

Section: Discussionmentioning

confidence: 99%

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

Habibi,

Kobets,

Boskabadi

et al. 2024

Neurosurg Rev

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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.

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“…Depending on the CT findings, prompt surgical evacuation of mass lesions or a primary decompressive craniectomy (DC) may be needed (e.g., see Fig. 1) [29 ▪▪ ]. A CT-angiogram should be performed in suspicion of traumatic cerebrovascular injuries such as skull base fractures involving the carotid canal [15].…”

Section: Emergency Department Managementmentioning

confidence: 99%

“…The Randomised Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute SubDural Haematoma (RESCUE-ASDH) trial comparing DC versus craniotomy showed that patients with traumatic ASDH who underwent craniotomy or primary DC (as a primary operation), disability and quality-of-life outcomes were similar with the two approaches with no added benefit of performing DC [29 ▪▪ ].…”

Section: Surgical Perspectivesmentioning

confidence: 99%

The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies

Hossain,

Rostami,

Marklund

2023

Current Opinion in Critical Care

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Purpose of review To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours. Recent findings Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials. Summary Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction.

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Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma

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Cited by 71 publications

References 22 publications

Comparing surgical outcomes: Craniotomy versus decompressive craniectomy in acute subdural hematoma - A systematic review and meta-analysis

Comparing surgical outcomes: Craniotomy versus decompressive craniectomy in acute subdural hematoma - A systematic review and meta-analysis

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

The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies

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