Effectiveness of Craniectomy Versus Craniotomy in the Management of Acute Subdural Hematoma Patients: A Systematic Review.

Traumatic brain injuries (TBIs) represent a spectrum of neurological conditions resulting from external forces impacting the head, leading to temporary or permanent impairments in cognitive, emotional, or physical functioning. Acute subdural hematomas (ASDH) are a significant subset of TBIs characterized by the rupture of blood vessels within the subdural space between the brain and the dura mater. Management of ASDH typically involves two primary surgical procedures: craniectomy and craniotomy. This review assessed the efficacy of these surgical approaches in treating patients with ASDH to determine whether one procedure provides superior patient outcomes compared to the other. Furthermore, it aimed to identify factors influencing surgical decisions about the type of procedure. A comprehensive literature search was conducted on ASDH patients undergoing craniotomy and craniectomy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis indicated that craniectomy was associated with higher mortality rates compared to craniotomy. Patients undergoing craniotomy had a statistically heightened likelihood of experiencing residual and rebleeding subdural hematoma. However, the incidence of increased intracranial pressure was significantly more pronounced in craniectomy compared to craniotomy. Follow-up Glasgow Coma Scale (GCS) scores, assessed six months post-surgery, suggested more favorable outcomes for patients who underwent craniotomy, albeit without statistical significance. Furthermore, this systematic review highlighted numerous factors influencing the choice of surgical approach, including the severity of the disease upon admission, patient age, and geographical location. Notably, patients exhibiting a GCS score of less than nine were more likely to be administered craniectomy. Additionally, younger patients, specifically those under 20 years of age with severe injuries, were more frequently subjected to craniectomy. In contrast, neurosurgeons in the United States and several European countries exhibited a preference for craniotomy, whereas craniectomy emerged as the predominant option for ASDH management in the United Kingdom. Ongoing research is essential to ascertain which surgical procedures yield superior patient outcomes within diverse cohorts of ASDH patients. Nonetheless, these findings underscore the critical need for continued investigation to refine surgical strategies and enhance patient outcomes in neurosurgery.