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Success of conservative therapy for chronic subdural hematoma patients: a systematic review
M Foppen1,2, Harssh Verdan Bandral1,2, Kari-Anne Mariam Slot1,2
1Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
Insights
Conservative therapy for chronic subdural hematoma (cSDH) is successful in 66% of mild-symptom patients. Factors like smaller hematoma volume may influence success, but more research is needed.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Conservative therapy is an option for chronic subdural hematoma (cSDH) patients with mild or no symptoms.
- This study aimed to determine the success rate of conservative therapy and identify influencing factors.
Approach:
- A systematic search of MEDLINE and EMBASE identified 11 studies with 1,019 patients.
- The primary outcome was the success rate, defined as no surgical intervention during follow-up.
- Pooled incidence and mean estimates were calculated using OpenMeta[Analyst].
Key Points:
- The pooled success rate for conservative therapy in cSDH was 66% (95% CI: 50-82%).
- One study linked smaller hematoma volume to success.
- Another study associated low hematoma density and absence of paresis with successful conservative management.
Conclusions:
- Conservative therapy is successful for most cSDH patients with mild symptoms.
- Hematoma volume, density, and absence of paresis may predict success.
- Further research is required to establish consistent predictors for successful conservative therapy.
Background:
Conservative therapy for chronic subdural hematoma (cSDH) is an option for patients who express no, or only mild symptoms, thereby preventing surgery in some. Because it is not clear for whom conservative therapy is successful, we aimed to estimate the success rate of conservative therapy and to identify which factors might influence success.
Methods:
We systematically searched MEDLINE and EMBASE databases to identify all available publications reporting outcome of conservative therapy for cSDH patients. Studies containing >10 patients were included. The primary outcome was the success rate of conservative therapy, defined as "no crossover to surgery" during follow-up. In addition, factors possibly associated with success of conservative therapy were explored. Bias assessment was performed with the Newcastle Ottowa Scale and the Cochrane risk-of-bias tool. We calculated pooled incidence and mean estimates, along with their 95% confidence intervals (CIs), using OpenMeta[Analyst] software.
Results:
The search yielded 1,570 articles, of which 11 were included in this study, describing 1,019 conservatively treated patients. The pooled success rate of conservative therapy was 66% (95% CI: 50-82%). One study (n = 98) reported smaller hematoma volume to be associated with success, whilst another study (n = 53) reported low hematoma density and absence of paresis at diagnosis to be associated with success.
Conclusion:
Conservative therapy is reported to be successful in the majority of cSDH patients who have either no, or only mild symptoms. Hematoma volume, low hematoma density and absence of paresis could be factors associated with success. However, further research is warranted in order to establish factors consistently associated with a successful conservative therapy.
Other:
No funding was acquired for this study. The study was not registered nor was a study protocol prepared.
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