Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma

Systematic Review and Meta-Analysis

Kevin Phan, Justin M. Moore, Christoph Griessenauer, Adam A. Dmytriw, Daniel B. Scherman, Sharaf Sheik-Ali, Nimer Adeeb, Christopher S. Ogilvy, Ajith Thomas, Jeffrey V. Rosenfeld

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)

Abstract

Background Acute subdural hematoma (SDH) is a major cause of morbidity after severe traumatic brain injury. Surgical evacuation of the hematoma, either via craniotomy or craniectomy, is the mainstay of treatment in patients with progressive neurologic deficits or significant mass effect. However, the decision to perform either procedure remains controversial. Methods A literature search using major online databases and a manual search of references on the topic of craniotomy and craniectomy for evacuation of subdural hematoma until September 2016 was performed. The outcome variables were analyzed which included residual SDH, revision rate, and clinical outcome. Results Six comparison studies, with a total number of 2006 craniotomy and 451 craniectomy patients, fulfilled the inclusion criteria. Patients who underwent craniectomy scored significantly lower on the Glasgow Coma Scale at the time of initial presentation. Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group than the craniotomy group (P = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1% vs. 60.1%, respectively; P = 0.004). Similarly, mortality rates was lower in the craniotomy group than the craniectomy group (P = 0.004). Conclusions The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment.

Original languageEnglish
Pages (from-to)677-685.e2
Number of pages11
JournalWorld Neurosurgery
Volume101
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • Craniectomy
  • Craniotomy
  • Decompression
  • Subdural hematoma
  • Traumatic brain injury

Cite this

Phan, Kevin ; Moore, Justin M. ; Griessenauer, Christoph ; Dmytriw, Adam A. ; Scherman, Daniel B. ; Sheik-Ali, Sharaf ; Adeeb, Nimer ; Ogilvy, Christopher S. ; Thomas, Ajith ; Rosenfeld, Jeffrey V. / Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma : Systematic Review and Meta-Analysis. In: World Neurosurgery. 2017 ; Vol. 101. pp. 677-685.e2.
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title = "Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis",
abstract = "Background Acute subdural hematoma (SDH) is a major cause of morbidity after severe traumatic brain injury. Surgical evacuation of the hematoma, either via craniotomy or craniectomy, is the mainstay of treatment in patients with progressive neurologic deficits or significant mass effect. However, the decision to perform either procedure remains controversial. Methods A literature search using major online databases and a manual search of references on the topic of craniotomy and craniectomy for evacuation of subdural hematoma until September 2016 was performed. The outcome variables were analyzed which included residual SDH, revision rate, and clinical outcome. Results Six comparison studies, with a total number of 2006 craniotomy and 451 craniectomy patients, fulfilled the inclusion criteria. Patients who underwent craniectomy scored significantly lower on the Glasgow Coma Scale at the time of initial presentation. Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group than the craniotomy group (P = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1{\%} vs. 60.1{\%}, respectively; P = 0.004). Similarly, mortality rates was lower in the craniotomy group than the craniectomy group (P = 0.004). Conclusions The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment.",
keywords = "Craniectomy, Craniotomy, Decompression, Subdural hematoma, Traumatic brain injury",
author = "Kevin Phan and Moore, {Justin M.} and Christoph Griessenauer and Dmytriw, {Adam A.} and Scherman, {Daniel B.} and Sharaf Sheik-Ali and Nimer Adeeb and Ogilvy, {Christopher S.} and Ajith Thomas and Rosenfeld, {Jeffrey V.}",
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Phan, K, Moore, JM, Griessenauer, C, Dmytriw, AA, Scherman, DB, Sheik-Ali, S, Adeeb, N, Ogilvy, CS, Thomas, A & Rosenfeld, JV 2017, 'Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis', World Neurosurgery, vol. 101, pp. 677-685.e2. https://doi.org/10.1016/j.wneu.2017.03.024

Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma : Systematic Review and Meta-Analysis. / Phan, Kevin; Moore, Justin M.; Griessenauer, Christoph; Dmytriw, Adam A.; Scherman, Daniel B.; Sheik-Ali, Sharaf; Adeeb, Nimer; Ogilvy, Christopher S.; Thomas, Ajith; Rosenfeld, Jeffrey V.

In: World Neurosurgery, Vol. 101, 01.05.2017, p. 677-685.e2.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma

T2 - Systematic Review and Meta-Analysis

AU - Phan, Kevin

AU - Moore, Justin M.

AU - Griessenauer, Christoph

AU - Dmytriw, Adam A.

AU - Scherman, Daniel B.

AU - Sheik-Ali, Sharaf

AU - Adeeb, Nimer

AU - Ogilvy, Christopher S.

AU - Thomas, Ajith

AU - Rosenfeld, Jeffrey V.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background Acute subdural hematoma (SDH) is a major cause of morbidity after severe traumatic brain injury. Surgical evacuation of the hematoma, either via craniotomy or craniectomy, is the mainstay of treatment in patients with progressive neurologic deficits or significant mass effect. However, the decision to perform either procedure remains controversial. Methods A literature search using major online databases and a manual search of references on the topic of craniotomy and craniectomy for evacuation of subdural hematoma until September 2016 was performed. The outcome variables were analyzed which included residual SDH, revision rate, and clinical outcome. Results Six comparison studies, with a total number of 2006 craniotomy and 451 craniectomy patients, fulfilled the inclusion criteria. Patients who underwent craniectomy scored significantly lower on the Glasgow Coma Scale at the time of initial presentation. Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group than the craniotomy group (P = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1% vs. 60.1%, respectively; P = 0.004). Similarly, mortality rates was lower in the craniotomy group than the craniectomy group (P = 0.004). Conclusions The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment.

AB - Background Acute subdural hematoma (SDH) is a major cause of morbidity after severe traumatic brain injury. Surgical evacuation of the hematoma, either via craniotomy or craniectomy, is the mainstay of treatment in patients with progressive neurologic deficits or significant mass effect. However, the decision to perform either procedure remains controversial. Methods A literature search using major online databases and a manual search of references on the topic of craniotomy and craniectomy for evacuation of subdural hematoma until September 2016 was performed. The outcome variables were analyzed which included residual SDH, revision rate, and clinical outcome. Results Six comparison studies, with a total number of 2006 craniotomy and 451 craniectomy patients, fulfilled the inclusion criteria. Patients who underwent craniectomy scored significantly lower on the Glasgow Coma Scale at the time of initial presentation. Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group than the craniotomy group (P = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1% vs. 60.1%, respectively; P = 0.004). Similarly, mortality rates was lower in the craniotomy group than the craniectomy group (P = 0.004). Conclusions The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment.

KW - Craniectomy

KW - Craniotomy

KW - Decompression

KW - Subdural hematoma

KW - Traumatic brain injury

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U2 - 10.1016/j.wneu.2017.03.024

DO - 10.1016/j.wneu.2017.03.024

M3 - Article

VL - 101

SP - 677-685.e2

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

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