Related Experiment Video
Updated: May 7, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Unilateral or bilateral drainage for patients with bilateral chronic subdural hematoma: a systematic review and
Merijn Foppen1,2,3, K Yah4,5, K M Slot4,5
1Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands. m.foppen@amsterdamumc.nl.
Insights
Unilateral surgery for bilateral chronic subdural hematoma (cSDH) requires additional contralateral surgery in 14% of cases. While bilateral drainage shows higher complication risks, both approaches yield similar outcomes in matched patient groups.
Area of Science:
- Neurosurgery
- Neurology
- Medical Research
Background:
- Bilateral chronic subdural hematoma (cSDH) presents treatment challenges, with unilateral drainage potentially leading to contralateral hematoma expansion.
- The choice between unilateral and bilateral drainage involves balancing reduced surgical risks against the need for potential future interventions.
Purpose of the Study:
- To determine the incidence of additional contralateral surgery after unilateral drainage for bilateral cSDH.
- To identify factors associated with the need for contralateral surgery.
- To compare outcomes of unilateral versus bilateral drainage in patients with bilateral cSDH.
Main Methods:
- A systematic review (SR) adhering to PRISMA guidelines was conducted to pool data on contralateral surgery incidence.
- Meta-analyses were performed to identify factors associated with contralateral treatment.
- A retrospective single-center cohort study evaluated outcomes of burr hole craniostomy for bilateral cSDH from 2010-2022.
Main Results:
- The pooled incidence of additional contralateral surgery after unilateral drainage was 14% (95% CI: 9-19%).
- Smaller ipsilateral and larger contralateral hematoma volumes were independently associated with the need for contralateral treatment.
- Bilateral drainage showed higher complication rates (9.9% vs. 1.5%) in the retrospective cohort, but outcomes were similar between approaches in subgroups with clinical equipoise and propensity score matching.
Conclusions:
- Approximately 14% of patients with bilateral cSDH undergoing unilateral drainage require subsequent contralateral surgery.
- While bilateral drainage may be associated with higher complication rates, unilateral and bilateral approaches demonstrate comparable outcomes in carefully selected patient groups.
- Further prospective studies are needed to establish optimal surgical strategies for bilateral cSDH.
Abstract:
Bilateral chronic subdural hematoma (cSDH) can be treated with unilateral or bilateral drainage. Unilateral drainage reduces surgery-related risks but could entail growth of the contralateral, non-operated hematoma. This study aims to (1) determine the incidence of additional contralateral surgery, (2) find factors associated with its occurrence, and (3) evaluate outcomes of uni- and bilateral drainage in bilateral cSDH patients. A systematic review (SR) conducted according to the PRISMA guidelines, pooled incidences of additional contralateral surgery with 95% confidence intervals (CI). Meta-analyses explored factors associated with contralateral surgery. Subsequently, a single-center, retrospective cohort study of bilateral cSDH patients treated with burr hole craniostomy (2010-2022) was performed. The primary outcome was occurrence of additional, contralateral surgery after unilateral drainage. Additionally, surgical complications, 30-day mortality, and reoperation rates (ipsilateral recurrence and additional contralateral surgery) were compared for unilateral and bilateral approaches in all patients and in two subgroups: cases with clinical equipoise regarding surgical approach and a propensity score-matched cohort. The pooled incidence of additional contralateral surgery in 697 patients (SR: 630, cohort: 67) receiving unilateral surgery was 14% (95% CI: 9-19%). Smaller ipsilateral hematoma (mean difference (MD): 12.2 ml, 95% CI: 7.18-17.23) and larger contralateral hematoma (MD: -25.4 ml, 95% CI: -43.95/-6.85) were independently associated with contralateral treatment (meta-analysis SR). Among 178 patients of the retrospective cohort, bilateral drainage had higher complication rates (9.9% vs. 1.5%, p = 0.032). In 93 patients with clinical equipoise and in 56 propensity score-matched patients, surgical approach did not affect reoperation, complications, or 30-day mortality rate. In patients with bilateral cSDH, additional contralateral treatment is required in 14% of all patients. Bilateral surgery carried higher complication risks in our cohort, but in the two subgroups, unilateral or bilateral approaches yielded similar outcomes. Prospective studies are required to further define in which patients unilateral surgery may suffice.
More Related Videos
09:14Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
Published on: June 18, 2021
05:17Author Spotlight: Scope of LE-ULBD as a Safe, Effective, and Minimally Invasive Approach to Treat Lumbar Spinal Stenosis
Published on: February 9, 2024
