Meta analysis of clinical efficacy of craniotomy and decompressive craniectomy for acute subdural hematoma

Objective To systematically evaluate the efficacy and safety of craniotomy and decompressive craniectomy in the treatment of acute subdural hematoma. Methods A systematic search was performed in PubMed, EMbase, the Cochrane Library, Web of science, China National Knowledge Infrastructure (CNKI), WanFang Data, and CBM databases up to June 2018 for the studies that provided comparisons between craniotomy hematoma evacuation and decompressive craniectomy for acute subdural hematoma. For the two categorical variables, the Odds Ratio (OR) and its 95% Confidence Interval (95% CI) are used. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. The meta analysis was performed using Stata/SE 12.0 software. Results A total of 8 studies were included in the meta analysis, of which 828 patients underwent craniotomy, and 663 patients underwent decompressive craniectomy. Meta analysis results showed that patients receiving decompressive craniectomy had a significantly lower Glasgow Coma Scale (GCS) when they first had symptoms. The residual rate of acute subdural hematoma in the decompressive craniectomy group was significantly lower than that in the craniotomy group (P=0.015), but there was no significant difference in the rate of reoperation. The incidence of poor outcome at following was lower in the craniotomy group compared with decompressive craniectomy group (50.1% vs 60.1%; P=0.003). Similarly, the mortality of the craniotomy group was lower than that of the decompressive craniectomy group (P=0.002). Conclusions Decompressive craniectomy may be the first choice for acute subdural hematoma, but the study is influenced by many factors and is not sufficient to provide definitive evidence. Key words: Hematoma, subdural, acute; Craniotomy; Decompressive craniectomy; Meta-analysis