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Updated: May 5, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Effectiveness of invasive interventions for chronic subdural hematoma: a systematic review
Victor B Amaral1, Rivaldo F Filho1, João V Fernandes1
1Department of Morphology, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
Insights
Managing chronic subdural hematoma (CSDH) with invasive treatments lacks clear guidelines. This review of randomized trials found limited evidence, highlighting the need for individualized patient care and further research on CSDH interventions.
Area of Science:
- Neurosurgery
- Neurology
- Evidence-Based Medicine
Background:
- Chronic subdural hematoma (CSDH) is a common neurological condition, particularly in the elderly, often presenting with headaches.
- The optimal invasive treatment strategy for CSDH remains a subject of ongoing debate.
- This systematic review focuses on assessing the efficacy and safety of various invasive interventions for CSDH.
Purpose of the Study:
- To systematically review randomized clinical trials (RCTs) on invasive interventions for chronic subdural hematoma (CSDH).
- To evaluate the efficacy and safety of different surgical approaches for CSDH treatment.
- To synthesize current evidence to inform clinical decision-making for CSDH management.
Main Methods:
- A comprehensive literature search was conducted across major databases following PRISMA guidelines.
- Study selection, data extraction, and bias assessment were performed independently by experts.
- The GRADE approach and RoB 2 tool were utilized to evaluate evidence quality and risk of bias.
Main Results:
- Four RCTs involving 579 patients were included, examining burr hole craniostomy, twist drill craniostomy, and subdural drainage.
- One study indicated shorter hospital stays with twist drill craniostomy compared to burr hole craniostomy.
- Findings on drainage duration and irrigation techniques showed varied outcomes across different studies.
Conclusions:
- The current evidence base for invasive interventions in CSDH is limited.
- Individualized treatment decisions considering patient factors, risks, and benefits are crucial.
- Larger-scale RCTs are necessary to establish definitive guidelines for CSDH treatment.
Introduction:
Chronic subdural hematoma (CSDH) is a frequent neurological problem, especially in older adults. It often presents headache as a primary symptom. The optimal approach to managing CSDH through invasive treatments is still debated, with various procedures available. We conducted a systematic review of randomized clinical trials, based on the most recent available literature, to assess the efficacy and safety of invasive interventions for the treatment of CSDH.
Evidence Acquisition:
A comprehensive search of major databases was performed according to PRISMA guidelines with an extensive consultation with experts that independently conducted study selection, data extraction, and bias assessment. The GRADE approach and RoB 2 tool were used to assess evidence quality and risk of bias.
Evidence Synthesis:
It was identified 4 studies (N.=579) meeting the inclusion criteria. Invasive interventions included burr hole craniostomy, twist drill craniostomy, and subdural drainage systems. Findings varied across studies. A Chinese study suggested shorter hospital stays with twist drill craniostomy compared to simple burr hole craniostomy. A Denmark study showed that the 48-hour drainage has a significantly higher volume of postoperative drain production compared to the 24-hour group. An Iranian study suggested fewer hematomas with burr hole irrigation without drainage compared to with drainage.
Conclusions:
Evidence on invasive interventions for CSDH is limited. Treatment decisions should be individualized based on patient factors and potential risks/benefits. Large-scale randomized controlled trials are needed to provide clearer guidelines for CSDH treatment.
