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Abstract：
BACKGROUND: Chronic subdural hematoma (CSDH) is a relatively common disease, especially in the elderly, for which there is no clear standard of treatment available. The authors systematically evaluated the efficacy of various surgical procedures for the treatment of chronic subdural hematoma.
METHODS: Electronic databases of PubMed, EmBase, Web of Science, Medicine, and the Cochrane Library were searched systematically. Based on the PRISMA template, we finally selected and analyzed 13 eligible papers to evaluate the effect of different drainage methods on CSDH. The primary outcomes were recurrence and clinical outcomes. Secondary outcomes were mortality and postoperative complications and other parameters.
RESULTS: The meta-analysis included 3 randomized controlled trials and 10 retrospective studies (non-randomized controlled trials) involving 3619 patients. The pooled results showed no statistically significant difference between non-subdural drainage (NSD) and subdural drainage (SD) in mortality and complication rates (P > 0.05). Additionally, overall pooled results showed that the use of NSD (10.9%) has a lower recurrence rate than the use of SD (11.7%), but the results were not statistically significant (relative risk ratio [RR] = 0.98; 95% confidence interval [CI] = 0.70-1.45; I2 = 47%; P = .92). However, the difference between NSD and SD in postoperative bleeding rate reached statistical significance (RR = 2.39; 95% CI = 1.31-4.36; I2 = 0 %; P = .004). Subgroup analysis showed that SD was associated with similar recurrent CSDH (RR = 0.75; 95% CI = 0.52-1.09; I2 = 0%; P = .14), good recovery (RR = 0.98; 95% CI = 0.93-1.04; I2 = 0%; P = .50), and mortality (RR = 0.98; 95% CI = 0.37-2.57; I2 = 0%; P = .96), compared to NSD.
CONCLUSIONS: These results suggest that NSD and SD are equally effective in the treatment of patients with CSDH, with no difference in final clinical characteristics and radiologic outcomes. However, in patients with limited subdural space after evacuation of a hematoma, NSD may be the preferred strategy to avoid iatrogenic brain injury.
METHODS: Electronic databases of PubMed, EmBase, Web of Science, Medicine, and the Cochrane Library were searched systematically. Based on the PRISMA template, we finally selected and analyzed 13 eligible papers to evaluate the effect of different drainage methods on CSDH. The primary outcomes were recurrence and clinical outcomes. Secondary outcomes were mortality and postoperative complications and other parameters.
RESULTS: The meta-analysis included 3 randomized controlled trials and 10 retrospective studies (non-randomized controlled trials) involving 3619 patients. The pooled results showed no statistically significant difference between non-subdural drainage (NSD) and subdural drainage (SD) in mortality and complication rates (P > 0.05). Additionally, overall pooled results showed that the use of NSD (10.9%) has a lower recurrence rate than the use of SD (11.7%), but the results were not statistically significant (relative risk ratio [RR] = 0.98; 95% confidence interval [CI] = 0.70-1.45; I2 = 47%; P = .92). However, the difference between NSD and SD in postoperative bleeding rate reached statistical significance (RR = 2.39; 95% CI = 1.31-4.36; I2 = 0 %; P = .004). Subgroup analysis showed that SD was associated with similar recurrent CSDH (RR = 0.75; 95% CI = 0.52-1.09; I2 = 0%; P = .14), good recovery (RR = 0.98; 95% CI = 0.93-1.04; I2 = 0%; P = .50), and mortality (RR = 0.98; 95% CI = 0.37-2.57; I2 = 0%; P = .96), compared to NSD.
CONCLUSIONS: These results suggest that NSD and SD are equally effective in the treatment of patients with CSDH, with no difference in final clinical characteristics and radiologic outcomes. However, in patients with limited subdural space after evacuation of a hematoma, NSD may be the preferred strategy to avoid iatrogenic brain injury.
摘要：
背景：慢性硬膜下血肿（CSDH）是一种相对常见的疾病，尤其是老年人，没有明确的治疗标准。作者系统评价了各种手术方法治疗慢性硬膜下血肿的疗效。
方法：PubMed的电子数据库，Embase,WebofScience,医学，对Cochrane图书馆进行了系统搜索。根据PRISMA模板，我们最终选择并分析了13篇符合条件的论文，以评估不同排水方法对CSDH的影响。主要结果是复发和临床结果。次要结果是死亡率和术后并发症和其他参数。
结果：荟萃分析包括3项随机对照试验和10项回顾性研究（非随机对照试验），涉及3619名患者。合并结果显示，非硬膜下引流术（NSD）和硬膜下引流术（SD）的死亡率和并发症发生率差异无统计学意义（P>0.05）。此外,总体汇总结果显示，使用NSD（10.9%）的复发率低于使用SD（11.7%），但结果无统计学意义(相对风险比[RR]=0.98;95%置信区间[CI]=0.70-1.45;I2=47%;P=0.92).然而,术后出血率NSD和SD差异有统计学意义(RR=2.39;95%CI=1.31~4.36;I2=0%;P=.004)。亚组分析显示，SD与类似的复发CSDH相关（RR=0.75；95％CI=0.52-1.09；I2=0％；P=.14），回收率良好(RR=0.98；95%CI=0.93-1.04；I2=0%；P=.50)，和死亡率（RR=0.98；95%CI=0.37-2.57；I2=0%；P=0.96），与NSD相比。
结论：这些结果表明，NSD和SD在治疗CSDH患者中同样有效，最终临床特征和放射学结果无差异。然而,在血肿清除后硬膜下间隙有限的患者中，NSD可能是避免医源性脑损伤的首选策略。
方法：PubMed的电子数据库，Embase,WebofScience,医学，对Cochrane图书馆进行了系统搜索。根据PRISMA模板，我们最终选择并分析了13篇符合条件的论文，以评估不同排水方法对CSDH的影响。主要结果是复发和临床结果。次要结果是死亡率和术后并发症和其他参数。
结果：荟萃分析包括3项随机对照试验和10项回顾性研究（非随机对照试验），涉及3619名患者。合并结果显示，非硬膜下引流术（NSD）和硬膜下引流术（SD）的死亡率和并发症发生率差异无统计学意义（P>0.05）。此外,总体汇总结果显示，使用NSD（10.9%）的复发率低于使用SD（11.7%），但结果无统计学意义(相对风险比[RR]=0.98;95%置信区间[CI]=0.70-1.45;I2=47%;P=0.92).然而,术后出血率NSD和SD差异有统计学意义(RR=2.39;95%CI=1.31~4.36;I2=0%;P=.004)。亚组分析显示，SD与类似的复发CSDH相关（RR=0.75；95％CI=0.52-1.09；I2=0％；P=.14），回收率良好(RR=0.98；95%CI=0.93-1.04；I2=0%；P=.50)，和死亡率（RR=0.98；95%CI=0.37-2.57；I2=0%；P=0.96），与NSD相比。
结论：这些结果表明，NSD和SD在治疗CSDH患者中同样有效，最终临床特征和放射学结果无差异。然而,在血肿清除后硬膜下间隙有限的患者中，NSD可能是避免医源性脑损伤的首选策略。
