Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Karan J. Yagnik ◽  
Anshit Goyal ◽  
Jamie J. Van Gompel
Keyword(s):  
Systematic Review ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Twist Drill

scholarly journals Hematoma Recurrence in Burr Hole Drainage Compared to Burr Hole Irrigation as Treatment of Chronic Subdural Hematoma: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (F) ◽  
pp. 97-102
Author(s):  
Sri Maliawan ◽  
Made Bhuwana Putra ◽  
Tjokorda GB Mahadewa ◽  
I Putu Eka Widyadharma
Keyword(s):  
Systematic Review ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Chronic Subdural Hematoma ◽  
Open Access Journal ◽  
Burr Hole ◽  
Recurrence Rates ◽  
Saline Irrigation

BACKGROUND: Subdural hematoma is a common phenomenon following a traumatic brain injury where a hematoma is formed below the dura mater of brain meningeal layer, usually with a coup-contrecoup mechanism of injury. The chronic counterpart of subdural hematoma is frequently occurring in elderly patients. There are several techniques being used by many practitioners, including burr hole with or without irrigation, with little evidence of which technique is favorable, especially in terms of recurrence rates following the procedure. AIM: This study aimed to compare the recurrences of chronic subdural hematoma (CSDH) following burr hole with and without saline irrigation technique by systematic review and meta-analysis. METHODS: This study included all articles that describe the two specified burr hole techniques in treating patients with a CSDH. We extracted the eligibility criteria into keywords using Boolean Operator. In this study, we used keywords (CSDH) and (burr hole) and (irrigation) and ((drainage) or no irrigation)) in PubMed, directory of open access journal, and Google Scholar database. RESULTS: This study included seven retrospective cohort studies from 2002 to 2017 with a total of 635 samples. The incidence of hematoma recurrences between burr hole irrigation and burr hole drainage was 14.7% and 12.0%, respectively. Based on random effect model with high heterogeneity (I2 = 60%; X2 = 14.92; p = 0.02), pooled risk ratio between burr hole irrigation and burr hole drainage on hematoma recurrences was 1.05 (p = 0.92; 95% confidence interval, 0.43–2.54). CONCLUSION: There was no superiority between one procedure toward other in preventing recurrences of chronic subdural hematoma.

Herbal medicine treatment for patients with chronic subdural hematoma: A systematic review and meta-analysis

2021 ◽  
Vol 43 ◽  
pp. 101307
Author(s):  
Seungwon Kwon ◽  
Chul Jin ◽  
Minho Chung ◽  
JiEun Lee ◽  
Seung-Yeon Cho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma

scholarly journals Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures

2014 ◽  
Vol 121 (3) ◽  
pp. 665-673 ◽  
Author(s):  
Weiming Liu ◽  
Nicolaas A. Bakker ◽  
Rob J. M. Groen
Keyword(s):  
Outcome Measures ◽  
Surgical Procedures ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Twist Drill ◽  
Recurrence Rates ◽  
Postoperative Drainage

Object In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T2 (tau-squared), I2, and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Results Of the 297 studies identified, 19 RCTs were included. Of them, 7 studies evaluated the use of postoperative drainage, of which the meta-analysis showed a pooled OR of 0.36 (95% CI 0.21–0.60; p < 0.001) in favor of drainage. Four studies compared twist drill and bur hole procedures. No significant differences between the 2 methods were present, but heterogeneity was considered to be significant. Three studies directly compared the use of irrigation before drainage. A fixed-effects meta-analysis showed a pooled OR of 0.49 (95% CI 0.21–1.14; p = 0.10) in favor of irrigation. Two studies evaluated postoperative posture. The available data did not reveal a significant advantage in favor of the postoperative supine posture. Regarding positioning of the catheter used for drainage, it was shown that a frontal catheter led to a better outcome. One study compared duration of drainage, showing that 48 hours of drainage was as effective as 96 hours of drainage. Conclusions Postoperative drainage has the advantage of reducing recurrence without increasing complications. The use of a bur hole or twist drill does not seem to make any significant difference in recurrence rates or other outcome measures. It seems that irrigation may lead to a better outcome. These results may lead to more standardized procedures.

Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis

2021 ◽  
pp. neurintsurg-2021-017352
Author(s):  
Natasha Ironside ◽  
Candice Nguyen ◽  
Quan Do ◽  
Beatrice Ugiliweneza ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Definitive Treatment ◽  
Complication Rates ◽  
Conventional Management ◽  
Meningeal Artery

Middle meningeal artery (MMA) embolization has been proposed as a minimally invasive treatment for chronic subdural hematoma (cSDH). The aim of this systematic review and meta-analysis is to compare outcomes after MMA embolization versus conventional management for cSDH. We performed a systematic review of PubMed, Embase, Oxford Journal, Cochrane, and Google Scholar databases from April 1987 to October 2020 in accordance with PRISMA guidelines. Studies reporting outcomes after MMA embolization for ≥3 patients with cSDH were included. A meta-analysis comparing MMA embolization with conventional management was performed. The analysis comprised 20 studies with 1416 patients, including 718 and 698 patients in the MMA embolization and conventional management cohorts, respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the MMA embolization cohort were 4.8% (95% CI 3.2% to 6.5%), 4.4% (2.8% to 5.9%), and 1.7% (0.8% to 2.6%), respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the conventional management cohort were 21.5% (0.6% to 42.4%), 16.4% (5.9% to 27.0%), and 4.9% (2.8% to 7.1%), respectively. Compared with conservative management, MMA embolization was associated with lower rates of cSDH recurrence (OR=0.15 (95% CI 0.03 to 0.75), p=0.02) and surgical rescue (OR=0.21 (0.07 to 0.58), p=0.003). In-hospital complication rates were comparable between the two cohorts (OR=0.78 (0.34 to 1.76), p=0.55). MMA embolization is a promising minimally invasive therapy that may reduce the need for surgical intervention in appropriately selected patients with cSDH. Additional prospective studies are warranted to determine the long-term durability of MMA embolization, refine eligibility criteria, and establish this endovascular approach as a viable definitive treatment for cSDH.

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