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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.
Insights
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.
Objective:
Initial management strategies of chronic subdural hematoma (cSDH) are controversial and range from bedside twist-drill or burr-hole drainage to craniotomy with membranectomy (CWM). We aim to 1) perform a meta-analysis of the available data on the outcomes of CWM for treatment of cSDH in published English-language literature and 2) evaluate collective outcomes of CWM with respect to morbidity, mortality, and recurrence rates.
Methods:
A search of English-language literature performed in PubMed, Ovid, and Cochrane databases using key words ("subdural hematoma" or "chronic subdural hematoma") and ("membrane" or "membranectomy") from inception to December 2016 was conducted. Studies reporting outcomes of CWM in cSDH were included. Mortality, morbidity, follow-up duration, and recurrence rate data were extracted and analyzed. Pooled estimates and confidence intervals (CIs) were calculated for all outcomes using a random-effects model.
Results:
Of 301 articles found, 17 articles containing 5369 patients met our eligibility criteria. Mean follow-up duration ranged from 1-30.8 months. Collective mean mortality and morbidity rates were 3.7% and 6.9%, respectively (95% CI 2-5.4% and 2.1-11.6%; P < 0.001 and P = 0.004). The collective mean recurrence rate was 7.6% (95% CI: 5%-10.2%; P < 0.001).
Conclusions:
Clinical data on outcomes of CWM in cSDH are limited to single institutional analyses, with considerable variation in recurrence rates and follow-up time. The rates we reported are comparable with the 5% mortality and 3%-12% morbidity rates and lower than the 10%-21% recurrence rate in the literature for burr holes or craniotomy without membranectomy. This meta-analysis provides an in-depth analysis of available data and reviews reported outcomes.
