Nadeem Abdullah, Siddiqui Tasmiyah, Rais Taruba, Munsab Rabbia, Habib Ashna, Afridi Eesha Khan, Shariq Fariha
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Dow University of Health Sciences, Mission Road, Karachi, Pakistan.
World Neurosurg X. 2024 Apr 3;23:100368. doi: 10.1016/j.wnsx.2024.100368. eCollection 2024 Jul.
Acute subdural hematomas (SDH) pose a significant health risk, often resulting from traumatic head injuries. The choice between surgical interventions, craniotomy, and decompressive craniectomy, remains a subject of debate. This meta-analysis aims to compare outcomes and guide clinical decision-making.
Following PRISMA guidelines, a comprehensive literature search was conducted in databases such as Ovid Medline, PubMed, and Cochrane, up to December 2023. Selection criteria included studies comparing craniotomy and decompressive craniectomy for acute SDH. Data extraction utilized the Newcastle-Ottawa Quality Assessment Tool, and statistical analysis employed the random-effects model.
The meta-analysis included 17 studies and 6848 patients. Craniotomy demonstrated a significant reduction in mortality rates (RR 0.80, 95% CI 0.73-0.89, < 0.0001). GCS scores favored craniotomy for severe cases. GOS outcomes showed a trend favoring craniotomy, particularly in good recovery (RR 1.34, 95% CI 1.04-1.74, = 0.03). Additional factors explored included co-existing sub-epidural hematoma, mydriasis, extracranial injuries, residual SDH, revision rates, and intracranial pressure.
The meta-analysis suggests that craniotomy may be a favorable surgical strategy for acute SDH, displaying a significant decrease in mortality rates and a lower risk of raised intracranial pressure. However, the nuanced nature of outcomes emphasizes the need for a tailored approach, considering broader clinical contexts. Future research should address limitations and provide a basis for well-informed clinical decision-making.
急性硬膜下血肿（SDH）构成重大健康风险，通常由头部外伤引起。手术干预（开颅手术和减压性颅骨切除术）之间的选择仍然是一个有争议的话题。本荟萃分析旨在比较疗效并指导临床决策。
按照PRISMA指南，截至2023年12月，在Ovid Medline、PubMed和Cochrane等数据库中进行了全面的文献检索。选择标准包括比较开颅手术和减压性颅骨切除术治疗急性SDH的研究。数据提取采用纽卡斯尔-渥太华质量评估工具，统计分析采用随机效应模型。
该荟萃分析纳入了17项研究和6848例患者。开颅手术显示死亡率显著降低（RR 0.80，95% CI 0.73 - 0.89，< 0.0001）。对于重症病例，格拉斯哥昏迷量表（GCS）评分更倾向于开颅手术。格拉斯哥预后量表（GOS）结果显示出倾向于开颅手术的趋势，尤其是在良好恢复方面（RR 1.34，95% CI 1.04 - 1.74，P = 0.03）。探讨的其他因素包括并存的硬膜外血肿、瞳孔散大、颅外损伤、残留SDH、翻修率和颅内压。
该荟萃分析表明，开颅手术可能是治疗急性SDH的一种有利手术策略，死亡率显著降低，颅内压升高风险较低。然而，结果的细微差别强调了需要采取量身定制的方法，考虑更广泛的临床背景。未来的研究应解决局限性问题，并为明智的临床决策提供依据。
