Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Neurosurg Rev. 2024 Mar 28;47(1):130. doi: 10.1007/s10143-024-02368-2.
Burr hole craniotomy is a common technique employed in the treatment of chronic subdural hematoma. However, its effectiveness and the occurrence of additional complications with various irrigation techniques utilized during the surgery remain unclear. The paper aims to compare the effectiveness and safety of burr hole craniotomy with and without irrigation in the treatment of chronic subdural hematoma. We conducted a systematic review by searching PubMed, Cochrane Library, Scopus, Ovid, and Web of Science for comparative studies that fit the eligibility criteria. All studies up to January 2023 were included, and the two groups were compared based on five primary outcomes using Review Manager Software. Data reported as odds ratio (OR) or risk ratio (RR) and 95% confidence interval (CI). A p-value of less than 0.05 was considered statistically significant. Our analysis included 12 studies with a total of 1581 patients. There was no significant difference between the two techniques in terms of recurrence rate (OR = 0.94; 95% CI [0.55, 1.06], p-value = 0.81) and mortality rate (RR = 1.05, 95% CI [0.46, 2.40], p-value = 0.91). Similarly, there was no significant difference in postoperative infection (RR = 1.15, 95% CI [0.16, 8.05], p-value = 0.89) or postoperative pneumocephalus (RR = 2.56, 95% CI [0.95, 6.89], p-value = 0.06). The burr hole drainage with irrigation technique was insignificantly associated with a higher risk of postoperative hemorrhagic complication (RR = 2.23, 95% CI [0.94, 5.29], p-value = 0.07); however, sensitivity analysis showed significant association based on the results of two studies (RR = 4.6, 95% CI [1.23, 17.25], p-value = 0.024). The two techniques showed comparable recurrence, mortality rate, postoperative infection, and postoperative pneumocephalus results. However, irrigation in burr hole craniotomy could possibly have a higher risk of postoperative hemorrhage compared with no irrigation, as observed during sensitivity analysis, which requires to be confirmed by other studies. Further research and randomized controlled trials are required to understand these observations better and their applicability in clinical practice.
颅骨钻孔术是治疗慢性硬膜下血肿的常用技术。然而，其有效性以及在手术过程中使用各种冲洗技术时出现的其他并发症尚不清楚。本文旨在比较颅骨钻孔术有无冲洗治疗慢性硬膜下血肿的效果和安全性。我们通过检索 PubMed、Cochrane 图书馆、Scopus、Ovid 和 Web of Science 来进行系统评价，以纳入符合入选标准的比较研究。所有研究截止至 2023 年 1 月，使用 Review Manager 软件根据 5 项主要结局对两组进行比较。数据以比值比（OR）或风险比（RR）和 95%置信区间（CI）报告。p 值小于 0.05 被认为具有统计学意义。我们的分析包括 12 项研究，共纳入 1581 名患者。两种技术在复发率（OR=0.94；95%CI[0.55，1.06]，p 值=0.81）和死亡率（RR=1.05，95%CI[0.46，2.40]，p 值=0.91）方面无显著差异。同样，术后感染（RR=1.15，95%CI[0.16，8.05]，p 值=0.89）或术后气颅（RR=2.56，95%CI[0.95，6.89]，p 值=0.06）也无显著差异。颅骨钻孔引流加冲洗技术与术后出血性并发症风险增加无显著相关性（RR=2.23，95%CI[0.94，5.29]，p 值=0.07）；然而，敏感性分析显示，根据两项研究的结果，两者之间存在显著相关性（RR=4.6，95%CI[1.23，17.25]，p 值=0.024）。两种技术的复发率、死亡率、术后感染和术后气颅结果相当。然而，敏感性分析显示，与无冲洗相比，颅骨钻孔术中冲洗可能会增加术后出血的风险，但这需要其他研究加以证实。需要进一步的研究和随机对照试验来更好地理解这些观察结果及其在临床实践中的适用性。
