Risk factors associated with Seizure after treatment of Chronic Subdural Hemorrhage: a systematic review and Meta-analysis

Introduction: Chronic Subdural Hemorrhage (CSDH) is a common neurosurgical condition, characterized by blood accumulation between the dura mater and arachnoid membrane. Age, gender, and medications such as anticoagulants and antiplatelets are often linked to CSDH recurrence risk; however, information on seizure risk is limited. This review aims to offer a thorough overview of seizure risk factors post-CSDH treatment.

Methods: A systematic search was performed in PubMed, Embase, SCOPUS, Cochrane Central, WOS and EBSCO for studies conducted up to September 11th, 2023. Studies aiming to assess risk factors associated with seizure after treatment of Chronic Subdural Hemorrhage were selected. In addition, only observational studies written in English, Spanish and Portuguese were included. Quality assessment was performed using the Newcastle-Ottawa scale for observational studies. A random effects model meta-analysis of risk was conducted, using the I2 statistics to measure the statistical heterogeneity. In addition, a metaregression was planned.

Results: A total of 1830 studies were screened after elimination of duplicates. A total of 18 studies were included, representing a total of 4829 patients. The pooled proportion of seizures after treatment of CSDH is 10% CI 95 [7%,13%; I2=93%]. The overall risk of seizures in Burr hole vs Craniotomy is OR 0.31 CI 95 [0.17, 0.54; I2=15%]. Furthermore, the overall risk of seizure in patients with and without prophylactic antiepileptic treatment is OR 2.62 CI 95 [0.53, 13.06; I2=66%]. Other risk factors reported included membranectomy, midline shift, Glasgow coma scale on admission, thickness of the haematoma and septations of the haematoma. A metaregression was not possible to perform due to the heterogeneity in the outcome reporting.

Conclusion : In conclusion, seizures are frequent complications of the treatment of cSDH. Burr hole treatment presents a significant lower risk of seizures compared with Craniotomy, and the use of prophylactic antiepileptic treatment did not conclusively affect seizure outcomes. Standardization in the reporting of outcomes and more prospective studies are needed to enable better recognition of risk factors.