Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis.
BACKGROUND
Acute subdural hematoma (SDH) is a major cause of morbidity after severe traumatic brain injury. Surgical evacuation of the hematoma, either via craniotomy or craniectomy, is the mainstay of treatment in patients with progressive neurologic deficits or significant mass effect. However, the decision to perform either procedure remains controversial.


METHODS
A literature search using major online databases and a manual search of references on the topic of craniotomy and craniectomy for evacuation of subdural hematoma until September 2016 was performed. The outcome variables were analyzed which included residual SDH, revision rate, and clinical outcome.


RESULTS
Six comparison studies, with a total number of 2006 craniotomy and 451 craniectomy patients, fulfilled the inclusion criteria. Patients who underwent craniectomy scored significantly lower on the Glasgow Coma Scale at the time of initial presentation. Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group than the craniotomy group (P = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1% vs. 60.1%, respectively; P = 0.004). Similarly, mortality rates was lower in the craniotomy group than the craniectomy group (P = 0.004).


CONCLUSIONS
The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment.
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia. Electronic address: kphan.vc@gmail.com.
Kevin
K
Phan
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Justin M
JM
Moore
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Christoph
C
Griessenauer
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Adam A
AA
Dmytriw
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.
Daniel B
DB
Scherman
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.
Sharaf
S
Sheik-Ali
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Nimer
N
Adeeb
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Christopher S
CS
Ogilvy
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Ajith
A
Thomas
Department of Neurosurgery, Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
Jeffrey V
JV
Rosenfeld
D003399:Craniotomy / Q000379:methods / Q000592:standards; D056424:Decompressive Craniectomy / Q000379:methods* / Q000592:standards*; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome
Craniectomy; Craniotomy; Decompression; Subdural hematoma; Traumatic brain injury