Director of Neurosurgery Hualien Tzu Chi Hospital Hualien City, TW
Introduction: Craniotomy has long been a primary treatment for symptomatic acute subdural hematoma, yet the debate over whether to replace the bone flap during the same surgery has persisted. This article aims to compare the characteristics and outcomes of craniotomy and decompressive craniectomy.
Methods: A comprehensive search of references from PubMed, Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and clinicaltrial.gov was conducted using keywords including 'acute subdural hematoma,' 'craniotomy, ' and 'craniectomy'. The search concluded in May 2023, focusing on a direct comparison of characteristics and outcomes between craniotomy and decompressive craniectomy. Meta-analysis was performed using Review Manager Version 5.3.
Results: A total of 16 references met the search criteria. Males were more likely to undergo decompressive craniectomy (OR 0.61, 95% CI 0.44-0.84, I² 75%; P=0.003). Patients undergoing craniotomy displayed significantly higher rates of a Glasgow Coma Scale (GCS) score greater than 8 upon admission, with an odds ratio (OR) of 1.96 (95% confidence interval [CI], 1.16-3.31, I² 66%; P=0.01). Furthermore, the craniotomy group exhibited significantly better GOSE scores( 4-5) at 6 months (OR 0.62, 95% CI 0.44-0.87, I² 6%; P=0.007). However, there was no statistically significant difference in the 1-year GOSE between the craniotomy and decompressive craniectomy groups.
Conclusion : These findings suggest that craniotomy is not inferior to decompressive craniectomy in terms of prognosis, as indicated by the GOSE results. However, it's important to note that most of the references used for this meta-analysis were not from randomized control trials, introducing a potential source of bias. Further randomized trials are warranted to determine if craniotomy alone suffices for acute subdural hematoma surgery.
