A comprehensive systematic review and meta-analysis study in comparing decompressive craniectomy versus craniotomy in patients with acute subdural hematoma.

Autor: Habibi MA; Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran., Kobets AJ; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467, USA., Boskabadi AR; Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran., Mousavi Nasab M; Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Sobhanian P; Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran., Saber Hamishegi F; Faculty of Medicine, Guilan University of Medical Science, Rasht, Iran., Naseri Alavi SA; Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467, USA. dr.arsalan2010@gmail.com.
Jazyk: angličtina
Zdroj: Neurosurgical review [Neurosurg Rev] 2024 Feb 10; Vol. 47 (1), pp. 77. Date of Electronic Publication: 2024 Feb 10.
DOI: 10.1007/s10143-024-02292-5
Abstrakt: There are two controversial surgery methods which are traditionally used: craniotomy and decompressive craniectomy. The aim of this study was to evaluate the efficacy and complications of DC versus craniotomy for surgical management in patients with acute subdural hemorrhage (SDH) following traumatic brain injury (TBI). We conducted a comprehensive search on PubMed, Scopus, Web of Science, and Embase up to July 30, 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Relevant articles were reviewed, with a focus on studies comparing decompressive craniectomy to craniotomy techniques in patients with SDH following TBI. Ten studies in 2401 patients were reviewed. A total of 1170 patients had a craniotomy, and 1231 had decompressive craniectomy. The mortality rate was not significantly different between the two groups (OR: 0.46 [95% CI: 0.42-0.5] P-value: 0.07). The rate of revision surgery was insignificantly different between the two groups (OR: 0.59 [95% CI: 0.49-0.69] P-value: 0.08). No significant difference was found between craniotomy and decompressive craniectomy regarding unilateral mydriasis (OR: 0.46 [95% CI: 0.35-0.57] P-value < 0.001). However, the craniotomy group had significantly lower rates of non-pupil reactivity (OR: 0.27 [95% CI: 0.17-0.41] P-value < 0.001) and bilateral mydriasis (OR: 0.59 [95% CI: 0.5-0.66] P-value: 0.04). There was also no significant difference in extracranial injury between the two groups, although the odds ratio of significant extracranial injury was lower in the craniotomy group (OR: 0.58 [95% CI: 0.45-0.7] P-value: 0.22). Our findings showed that non-pupil and bilateral-pupil reactivity were significantly more present in decompressive craniectomy. However, there was no significant difference between the two groups regarding mortality rate, extracranial injury, revision surgery, and one-pupil reactivity.
(© 2024. The Author(s).)
Databáze: MEDLINE
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