Abstract：
OBJECTIVE: Acute subdural hematoma (ASDH) is a common critical neurosurgical condition, often requiring immediate surgical intervention. Craniotomy and decompressive craniectomy are the 2 mainstay surgical approaches. This comprehensive review and meta-analysis aims to summarize the existing evidence and compare the outcomes of these 2 procedures.
METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL electronic databases were searched for relevant studies, published between inception of databases till June 2023. Eligible studies reported data of patients diagnosed with ASDH who underwent craniotomy or decompressive craniectomy for ASDH. Outcome measures included the Glasgow Coma Scale score, residual subdural hematoma, requirement of revision surgery, poorer outcomes, and mortality. Data were presented as pooled odds ratios with 95% confidence intervals. Quality assessment and risk of bias were performed for each study.
RESULTS: Fourteen studies with a total of 3095 patients were included. The results showed that patients who underwent craniotomy had significantly lower mortality, lower odds of poorer outcomes, and a higher rate of residual subdural hematoma, compared to patients who underwent decompressive craniectomy. There was no significant difference in the requirement of revision surgery between the 2 groups. Heterogeneity was high for most outcomes, and the quality of evidence ranged from moderate to low.
CONCLUSIONS: Our findings suggest that craniotomy is associated with better clinical outcomes and lower mortality compared to decompressive craniectomy for ASDH, but a higher rate of residual subdural hematoma. Further high-quality randomized controlled trials are needed to validate our findings.
METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL electronic databases were searched for relevant studies, published between inception of databases till June 2023. Eligible studies reported data of patients diagnosed with ASDH who underwent craniotomy or decompressive craniectomy for ASDH. Outcome measures included the Glasgow Coma Scale score, residual subdural hematoma, requirement of revision surgery, poorer outcomes, and mortality. Data were presented as pooled odds ratios with 95% confidence intervals. Quality assessment and risk of bias were performed for each study.
RESULTS: Fourteen studies with a total of 3095 patients were included. The results showed that patients who underwent craniotomy had significantly lower mortality, lower odds of poorer outcomes, and a higher rate of residual subdural hematoma, compared to patients who underwent decompressive craniectomy. There was no significant difference in the requirement of revision surgery between the 2 groups. Heterogeneity was high for most outcomes, and the quality of evidence ranged from moderate to low.
CONCLUSIONS: Our findings suggest that craniotomy is associated with better clinical outcomes and lower mortality compared to decompressive craniectomy for ASDH, but a higher rate of residual subdural hematoma. Further high-quality randomized controlled trials are needed to validate our findings.
摘要：
目的：急性硬膜下血肿（ASDH）是神经外科常见的危重疾病，通常需要立即手术干预。开颅手术和去骨瓣减压术是两种主要的手术方法。本综述和荟萃分析旨在总结现有证据并比较这两种方法的结果。
方法：PubMed，Embase,Cochrane中央对照试验登记册（中央），和CINAHL电子数据库进行了相关研究，在数据库开始到2023年6月之间发布。符合条件的研究报告了诊断为ASDH的患者接受开颅手术或去骨瓣减压术的数据。结果指标包括格拉斯哥昏迷量表评分，残余硬膜下血肿（SDH），翻修手术的要求，较差的结果，和死亡率。数据以具有95%置信区间(CIs)的合并比值比(ORs)呈现。对每项研究进行质量评估和偏倚风险。
结果：共纳入了14项研究，共3095名患者。结果显示,接受开颅手术的患者死亡率明显降低,结果较差的可能性较低，和较高的残留SDH率，与接受去骨瓣减压术的患者相比。两组患者的翻修手术需求差异无统计学意义。大多数结果的异质性很高，证据质量从中度到低度不等。
结论：我们的研究结果表明，与去骨瓣减压术治疗ASDH相比，开颅手术具有更好的临床结局和更低的死亡率。但残留SDH率较高。需要进一步的高质量随机对照试验来验证我们的发现。
方法：PubMed，Embase,Cochrane中央对照试验登记册（中央），和CINAHL电子数据库进行了相关研究，在数据库开始到2023年6月之间发布。符合条件的研究报告了诊断为ASDH的患者接受开颅手术或去骨瓣减压术的数据。结果指标包括格拉斯哥昏迷量表评分，残余硬膜下血肿（SDH），翻修手术的要求，较差的结果，和死亡率。数据以具有95%置信区间(CIs)的合并比值比(ORs)呈现。对每项研究进行质量评估和偏倚风险。
结果：共纳入了14项研究，共3095名患者。结果显示,接受开颅手术的患者死亡率明显降低,结果较差的可能性较低，和较高的残留SDH率，与接受去骨瓣减压术的患者相比。两组患者的翻修手术需求差异无统计学意义。大多数结果的异质性很高，证据质量从中度到低度不等。
结论：我们的研究结果表明，与去骨瓣减压术治疗ASDH相比，开颅手术具有更好的临床结局和更低的死亡率。但残留SDH率较高。需要进一步的高质量随机对照试验来验证我们的发现。
