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Membranectomy in Chronic Subdural Hematoma: Meta-Analysis.
Ronald Sahyouni1, Hossein Mahboubi2, Peter Tran3
1School of Medicine MSTP, University of California, Irvine, California, USA; Department of Biomedical Engineering, University of California, Irvine, California, USA.
World Neurosurgery
|May 18, 2017
Summary
Craniotomy with membranectomy (CWM) for chronic subdural hematoma (cSDH) shows promising outcomes. This meta-analysis found CWM to have lower recurrence rates compared to other surgical options for cSDH.
Area of Science:
- Neurosurgery
- Medical Outcomes Research
Background:
- Management of chronic subdural hematoma (cSDH) involves varied surgical approaches, including twist-drill, burr-hole drainage, and craniotomy with membranectomy (CWM).
- Optimal surgical strategy for cSDH remains a subject of debate, necessitating comprehensive outcome analysis.
Purpose of the Study:
- To conduct a meta-analysis of published English-language literature on the outcomes of CWM for cSDH treatment.
- To evaluate the collective morbidity, mortality, and recurrence rates associated with CWM in cSDH patients.
Main Methods:
- A systematic literature search was performed across PubMed, Ovid, and Cochrane databases up to December 2016.
- Included studies reported outcomes of CWM for cSDH, extracting data on mortality, morbidity, follow-up duration, and recurrence.
- Pooled estimates and confidence intervals were calculated using a random-effects model.
Main Results:
- Seventeen articles comprising 5369 patients met the inclusion criteria.
- The collective mean mortality rate was 3.7% (95% CI 2-5.4%), and morbidity rate was 6.9% (95% CI 2.1-11.6%).
- The collective mean recurrence rate was 7.6% (95% CI 5%-10.2%).
Conclusions:
- The reported mortality and morbidity rates for CWM are comparable to existing literature for other surgical interventions.
- CWM demonstrated a lower recurrence rate (7.6%) compared to craniotomy without membranectomy (10%-21%).
- Clinical data on CWM outcomes are primarily from single institutions, highlighting a need for further multi-center studies.
