Ali Syed Hasham, Tharwani Zoaib Habib, Siddiqui Asad Ali, Iqbal Fizza, Sadiq Mahnoor, Abdullah Ali, Khalid Abdullah, Ansari Huzaifa Ul Haq, Usman Muhammad, Qazi Shurjeel Uddin, Munaf Uzair, Haque Ibtehaj Ul, Marsia Shayan
Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan.
Department of Medicine, Sindh Medical College, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan.
J Cent Nerv Syst Dis. 2024 Nov 3;16:11795735241297250. doi: 10.1177/11795735241297250. eCollection 2024.
Acute subdural hematomas are major causes of morbidity which warrant immediate treatment. If surgical intervention is warranted, craniotomy (CO) and decompressive craniectomy (DC) are employed, largely based on a loosely defined criteria and the neurosurgeon's best judgment. The primacy of one approach over another is a matter of dispute.
We attempt to further clarify any advantages in the two techniques, and include a propensity score matched (PSM) subgroup analysis to eliminate bias.
This meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
A literature review was conducted on PubMed/Medline, Cochrane Central, and Google Scholar from inception to September 2023. 15 studies were extracted, and three outcomes were meta-analyzed: Mortality, Glasgow Outcome Scale (GOS) scores and patients undergoing re-operations/revisions. Odds Ratios (OR) and Mean Difference (MD) were used in dichotomous and continuous variables respectively. PSM data was used wherever possible. A subgroup analysis was conducted with 5 PSM studies and a trial. Heterogeneity was addressed if above 40% and the -value is significant (≤ .05).
A total of 15 studies were meta-analyzed with a total of 2327 and 2171 patients undergoing CO and DC respectively. Patients undergoing DC had a significantly worse GOS 5 outcome (OR: .63 [95% CI: .45-.87]; = .005; I2 = 0%) and higher mortality (OR: 1.58 [95% CI: 1.20-2.08]; = .001; I2 = 67%). In subgroup analysis of adjusted studies, DC still had significantly higher mortality. (OR: 1.50 [95% CI: 1.03-2.18]; = .001; I2 = 83%).
This meta-analysis determines that CO is more viable than DC as a surgical option due to its less invasive nature. DC can be employed, albeit under strict preprocedural patient selection and for highly specific indications.
急性硬膜下血肿是导致发病的主要原因，需要立即治疗。如果需要进行手术干预，主要采用开颅手术（CO）和减压性颅骨切除术（DC），这在很大程度上基于定义模糊的标准和神经外科医生的最佳判断。一种方法相对于另一种方法的首要地位存在争议。
我们试图进一步阐明这两种技术的任何优势，并进行倾向评分匹配（PSM）亚组分析以消除偏差。
本荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。
对PubMed/Medline、Cochrane Central和谷歌学术从创立到2023年9月进行文献综述。提取了15项研究，并对三个结果进行荟萃分析：死亡率、格拉斯哥预后量表（GOS）评分以及接受再次手术/翻修的患者。比值比（OR）和平均差（MD）分别用于二分变量和连续变量。尽可能使用PSM数据。对5项PSM研究和一项试验进行了亚组分析。如果异质性高于40%且P值显著（≤0.05），则对其进行处理。
共对15项研究进行了荟萃分析，分别有2327例和2171例患者接受了CO和DC治疗。接受DC治疗的患者GOS 5结局显著更差（OR：0.63[95%CI：0.45 - 0.87]；P = 0.005；I² = 0%）且死亡率更高（OR：1.58[95%CI：1.20 - 2.08]；P = 0.001；I² = 67%）。在调整后研究的亚组分析中，DC的死亡率仍然显著更高。（OR：1.50[95%CI：1.03 - 2.18]；P = 0.001；I² = 83%）。
本荟萃分析确定，由于其侵入性较小，CO作为一种手术选择比DC更可行。DC可以采用，尽管需要在严格的术前患者选择和高度特定的适应症情况下使用。
