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Updated: Jun 25, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Management of Chronic Subdural Hematoma: A Systematic Review and Component Network Meta-analysis of 455 Studies With
Jack Henry1,2, Michael Amoo1,3, Malia Kissner2
1National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
Insights
Chronic subdural hematoma (CSDH) recurrence is about 10% after surgery. Postoperative drains and middle meningeal artery embolization reduce recurrence risk, while corticosteroids show mixed results with increased morbidity.
Area of Science:
- Neurosurgery
- Medical Treatments
- Systematic Reviews
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition.
- CSDH poses a significant risk of recurrence following treatment.
Approach:
- A comprehensive systematic review and meta-analysis was conducted.
- Searched major databases (PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science) from 2000 to 2021.
- Component network meta-analyses (CNMAs) evaluated surgical and medical treatments for recurrence and morbidity.
Key Points:
- Recurrence rates after surgery for CSDH approximate 10.8%.
- Postoperative drains (iRR 0.53) and middle meningeal artery embolization (iRR 0.19) significantly reduced surgical recurrence.
- Corticosteroids lowered recurrence risk (iRR 0.47) but increased morbidity (iRR 1.34); surgical intervention also reduced recurrence (iRR 0.11).
Conclusions:
- Surgical interventions for CSDH demonstrate comparable morbidity rates.
- Middle meningeal artery embolization is a promising CSDH treatment requiring further randomized trials.
- While corticosteroids decrease CSDH recurrence, they are linked to elevated morbidity.
Background:
Chronic subdural hematoma (CSDH) is a common neurosurgical condition with a high risk of recurrence after treatment.
Objective:
To assess and compare the risk of recurrence, morbidity, and mortality across various treatments for CSDH.
Methods:
A systematic review and meta-analysis was performed. PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science were searched from January 01, 2000, to July 07, 2021. The primary outcome was recurrence, and secondary outcomes were morbidity and mortality. Component network meta-analyses (CNMAs) were performed for surgical and medical treatments, assessing recurrence and morbidity. Incremental risk ratios (iRRs) with 95% CIs were estimated for each component.
Results:
In total, 12 526 citations were identified, and 455 studies with 103 645 cases were included. Recurrence occurred in 11 491/93 525 (10.8%, 95% CI 10.2-11.5, 418 studies) cases after surgery. The use of a postoperative drain (iRR 0.53, 95% CI 0.44-0.63) and middle meningeal artery embolization (iRR 0.19, 95% CI 0.05-0.83) reduced recurrence in the surgical CNMA. In the pharmacological CNMA, corticosteroids (iRR 0.47, 95% CI 0.36-0.61) and surgical intervention (iRR 0.11, 95% CI 0.07-0.15) were associated with lower risk. Corticosteroids were associated with increased morbidity (iRR 1.34, 95% CI 1.05-1.70). The risk of morbidity was equivalent across surgical treatments.
Conclusion:
Recurrence after evacuation occurs in approximately 10% of cSDHs, and the various surgical interventions are approximately equivalent. Corticosteroids are associated with reduced recurrence but also increased morbidity. Drains reduce the risk of recurrence, but the position of drain (subdural vs subgaleal) did not influence recurrence. Middle meningeal artery embolization is a promising treatment warranting further evaluation in randomized trials.
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