Amaral Victor B, Filho Rivaldo F, Fernandes João V, Neto Olavo B, Oliveira André S
Department of Morphology, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
Department of Anatomy, Federal University of Alagoas, Maceió, Brazil.
J Neurosurg Sci. 2025 Apr;69(2):200-209. doi: 10.23736/S0390-5616.25.06356-8. Epub 2025 Mar 19.
Chronic subdural hematoma (CSDH) is a frequent neurological problem, especially in older adults. It often presents headache as a primary symptom. The optimal approach to managing CSDH through invasive treatments is still debated, with various procedures available. We conducted a systematic review of randomized clinical trials, based on the most recent available literature, to assess the efficacy and safety of invasive interventions for the treatment of CSDH.
A comprehensive search of major databases was performed according to PRISMA guidelines with an extensive consultation with experts that independently conducted study selection, data extraction, and bias assessment. The GRADE approach and RoB 2 tool were used to assess evidence quality and risk of bias.
It was identified 4 studies (N.=579) meeting the inclusion criteria. Invasive interventions included burr hole craniostomy, twist drill craniostomy, and subdural drainage systems. Findings varied across studies. A Chinese study suggested shorter hospital stays with twist drill craniostomy compared to simple burr hole craniostomy. A Denmark study showed that the 48-hour drainage has a significantly higher volume of postoperative drain production compared to the 24-hour group. An Iranian study suggested fewer hematomas with burr hole irrigation without drainage compared to with drainage.
Evidence on invasive interventions for CSDH is limited. Treatment decisions should be individualized based on patient factors and potential risks/benefits. Large-scale randomized controlled trials are needed to provide clearer guidelines for CSDH treatment.
慢性硬膜下血肿（CSDH）是一个常见的神经学问题，尤其在老年人中。它常以头痛作为主要症状。通过侵入性治疗来管理CSDH的最佳方法仍存在争议，有多种可用的手术方式。我们基于最新可得文献对随机临床试验进行了系统综述，以评估侵入性干预治疗CSDH的疗效和安全性。
根据PRISMA指南对主要数据库进行了全面检索，并与独立进行研究选择、数据提取和偏倚评估的专家进行了广泛咨询。采用GRADE方法和RoB 2工具来评估证据质量和偏倚风险。
确定了4项符合纳入标准的研究（N = 579）。侵入性干预包括钻孔开颅术、锥颅术和硬膜下引流系统。各研究结果各异。一项中国研究表明，与单纯钻孔开颅术相比，锥颅术的住院时间更短。一项丹麦研究显示，48小时引流组术后引流量明显高于24小时组。一项伊朗研究表明，钻孔冲洗不引流组的血肿比引流组更少。
关于CSDH侵入性干预的证据有限。治疗决策应根据患者因素以及潜在风险/益处进行个体化。需要大规模随机对照试验为CSDH治疗提供更明确的指导方针。
