Advancing Surgical Strategies and enhancing Surgical Success in Chronic Subdural Hematoma: An Umbrella Review and Meta-Analytic Guide for Neurosurgeons
Ibrahim Serag1, Mohamed Abouzid2, Ahmed Aljabali3, Ibraheem Alkhawaldeh4, Mostafa Hossam El Din Moawad5, Ahmed Negida6
1Faculty of Medicine, Mansoura University, 2Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, 3faculty of medicine jordan university, 4Faculty of Medicine, Mutah University, Al-Karak, Jordan, 5Faculty of Pharmacy Clinical Department, Alexandria University, Alexandria, Egypt., 6Virginia Commonwealth University
Objective:
This study aimed to evaluate various surgical and postoperative strategies for managing CSDH through five systematic reviews and meta-analyses.
Background:
Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, especially among the elderly, associated with notable mortality and morbidity. Surgical intervention remains the primary treatment. However, recurrence rates of CSDH remain high, ranging from 5% to 30%.
Design/Methods:
We conducted five systematic reviews and meta-analyses to evaluate various surgical and postoperative strategies in CSDH treatment. The study followed PRISMA guidelines, systematically searching many databases. Statistical analyses were performed using RevMan software.
Results:
A total of 12,263 patients across our five studies were included in the analysis, and we found that drainage significantly reduces recurrence (OR = 0.39, 95% CI 0.28 to 0.55; P < 0.00001), mortality (OR= 0.65, 95% CI [0.43–0.97];P = 0.04), and gross focal neurological deficits (OR = 0.58, 95% CI [0.37–0.89]; P = 0.01) compared to non-drainage. Irrigation showed a significant increase in postoperative hemorrhagic complications during sensitivity analysis (RR = 4.6, 95% CI [1.23–17.25]; P = 0.024). Local anesthesia was associated with less complications (OR = 2.4, 95% CI [1.81–3.17]; P < 0.00001), shorter hospital stays (SMD = 1.19 days, 95% CI [1.06–1.32]; P < 0.00001), and reduced surgery duration (SMD = 0.94 h, 95% CI [0.67–1.2]; P < 0.00001) in comparison to general anesthesia. Head position post-surgery (supine vs. elevated) showed no significant difference in recurrence rates , second interventions, or postoperative complications . subperiosteal/subgaleal drainage demonstrated lower recurrence rates (OR = 0.81, 95% CI [0.66–1]; P = 0.05) and reduced postoperative brain injuries (OR = 0.53, 95% CI [0.30–0.93]; P = 0.03) compared to subdural drainage.
Conclusions:
our meta analyses revealed the effectiveness of drainage in reducing recurrence and mortality rates in CSDH surgery. We advise neurosurgeons to prioritize using drainage especially subperiosteal/subgaleal drainage, favor local anesthesia for its safety.
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