Top

Published in:

01-12-2024 | Craniotomy | Review Article

Surgical strategies in acute subdural hematoma: a meta-analysis of decompressive craniectomy vs. craniotomy

Authors: Muhammad Ashir Shafique, Muhammad Saqlain Mustafa, Brandon Luke-Wold, Aashish Kumar, Burhanuddin Sohail Rangwala, Muhammad Abdullah, Syed Muhammad Sinaan Ali, Javed Iqbal, Abdul Haseeb

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Objective

Acute subdural hematoma (ASDH) stands as a significant contributor to morbidity after severe traumatic brain injuries (TBI). The primary treatment approach for patients experiencing progressive neurological deficits or notable mass effects is the surgical removal of the hematoma, which can be achieved through craniotomy (CO) or decompressive craniectomy (DC). Nevertheless, the choice between these two procedures remains a subject of ongoing debate and controversy.

Materials and methods

We conducted a comprehensive literature review, utilizing prominent online databases and manually searching references related to craniotomy and craniectomy for subdural hematoma evacuation up to November 2023. Our analysis focused on outcome variables such as the presence of residual subdural hematoma, the need for revision procedures, and overall clinical outcomes.

Results

We included a total of 11 comparative studies in our analysis, encompassing 4269 patients, with 2979 undergoing craniotomy and 1290 undergoing craniectomy, meeting the inclusion criteria. Patients who underwent craniectomy displayed significantly lower scores on the Glasgow Coma Scale (GCS) during their initial presentation. Following surgery, the DC group exhibited a significantly reduced rate of residual subdural (P = 0.009). Additionally, the likelihood of a poor outcome during follow-up was lower in the CO group. Likewise, the mortality rate was lower in the CO group compared to the craniectomy group (OR 0.63, 95% CI 0.41–0.98, I² = 84%, P = 0.04).

Conclusion

Our study found that CO was associated with more favorable outcomes in terms of mortality, reoperation rate, and functional outcome while DC was associated with less likelihood of residual subdural hematoma. Upon further investigation of patient characteristics who underwent into either of these interventions, it was very clear that patients in DC cohort have more serious and low pre-op characteristics than the CO group. Nonetheless, brain herniation and advanced age act as independent factor for predicting the outcome irrespective of the intervention.

Available only for authorised users

A study to test the safety and efficacy of the drug larotrectinib for the treatment of tumors with NTRK-fusion in children (SCOUT) [Available from: https://clinicaltrials.gov/study/NCT02637687. Accessed 25 Nov 2023

Ahmed N, Greenberg P, Shin S (2021) Mortality outcome of emergency decompressive craniectomy and craniotomy in the management of acute subdural hematoma: a national data analysis. Am Surg 87(3):347–353PubMedCrossRef

Anis SB, Khan SA, Mitha R, Shamim MS (2022) Craniotomy or craniectomy for acute subdural hematoma? Difference in patient characteristics and outcomes at a tertiary care hospital. Asian J Neurosurg 17(4):563–567PubMedPubMedCentralCrossRef

Ban SP, Son YJ, Yang HJ, Chung YS, Lee SH, Han DH (2010) Analysis of complications following decompressive craniectomy for traumatic brain injury. J Korean Neurosurg Soc 48(3):244–250PubMedPubMedCentralCrossRef

Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW et al (2006) Surgical management of acute subdural hematomas. Neurosurgery 58(3 Suppl):S16-24 discussion Si-ivPubMed

Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ et al (2017) Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80(1):6–15PubMedCrossRef

Chen SH, Chen Y, Fang WK, Huang DW, Huang KC, Tseng SH (2011) Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma 71(6):1632–1636PubMed

Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P et al (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364(16):1493–1502PubMedCrossRef

d’Avella D, Servadei F, Scerrati M, Tomei G, Brambilla G, Massaro F et al (2003) Traumatic acute subdural haematomas of the posterior fossa: clinicoradiological analysis of 24 patients. Acta Neurochir 145:1037–1044PubMedCrossRef

10.

Delgado-López PD, Martín-Velasco V, Castilla-Díez J, Galacho-Harriero A, Rodríguez-Salazar A (2009) Preservation of bone flap after craniotomy infection. Neurocirugia 20(2):124–131PubMedCrossRef

11.

Desai VR, Grossman R, Sparrow H (2016) Incidence of intracranial hemorrhage after a cranial operation. Cureus 8(5):e616PubMedPubMedCentral

12.

Godil SS, Shamim MS, Enam SA, Qidwai U, Qadeer M, Sobani ZA (2011) Cranial reconstruction after decompressive craniectomy: prediction of complications using fuzzy logic. J Craniofac Surg 22(4):1307–1311PubMedCrossRef

13.

Hanif S, Abodunde O, Ali Z, Pidgeon C (2009) Age related outcome in acute subdural haematoma following traumatic head injury. Ir Med J 102(8):255–257PubMed

14.

Hatashita S, Koga N, Hosaka Y, Takagi S (1993) Acute subdural hematoma: severity of injury, surgical intervention, and mortality. Neurol Med Chir (Tokyo) 33(1):13–18PubMedCrossRef

15.

Hlatky R, Valadka AB, Goodman JC, Robertson CS (2007) Evolution of brain tissue injury after evacuation of acute traumatic subdural hematomas. Neurosurgery 61(1):SHC-249-SHC−55CrossRef

16.

Hutchinson PJ, Adams H, Mohan M, Devi BI, Uff C, Hasan S et al (2023) Decompressive craniectomy versus craniotomy for acute subdural hematoma. N Engl J Med 388(24):2219–2229PubMedCrossRef

17.

Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J et al (2016) Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 375(12):1119–1130PubMedCrossRef

18.

Jeon JS, Chang IB, Cho BM, Lee HK, Hong SK, Oh SM (2006) Immediate postoperative epidural hematomas adjacent to the craniotomy site. J Korean Neurosurg Soc 39(5):335–339

19.

Koç RK, Akdemir H, Oktem IS, Meral M, Menkü A (1997) Acute subdural hematoma: outcome and outcome prediction. Neurosurg Rev 20(4):239–244PubMedCrossRef

20.

Kolias AG, Belli A, Li LM, Timofeev I, Corteen EA, Santarius T et al (2012) Primary decompressive craniectomy for acute subdural haematomas: results of an international survey. Acta Neurochir (Wien) 154(9):1563–1565PubMedCrossRef

21.

Kolias AG, Scotton WJ, Belli A, King AT, Brennan PM, Bulters DO et al (2013) Surgical management of acute subdural haematomas: current practice patterns in the United Kingdom and the Republic of Ireland. Br J Neurosurg 27(3):330–333PubMedCrossRef

22.

Kourbeti IS, Vakis AF, Ziakas P, Karabetsos D, Potolidis E, Christou S et al (2015) Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis. J Neurosurg 122(5):1113–1119PubMedCrossRef

23.

Kuhn EN, Chagoya G, Agee BS, Harrigan MR (2018) Suboccipital craniotomy versus craniectomy: a survey of practice patterns. World Neurosurg 109:e731–e738PubMedCrossRef

24.

Kwon YS, Yang KH, Lee YH (2016) Craniotomy or decompressive craniectomy for acute subdural hematomas: surgical selection and clinical outcome. Korean J Neurotrauma 12(1):22–27PubMedPubMedCentralCrossRef

25.

Lanzieri CF, Larkins M, Mancall A, Lorig R, Duchesneau PM, Rosenbloom SA et al (1988) Cranial postoperative site: MR imaging appearance. AJNR Am J Neuroradiol 9(1):27–34PubMedPubMedCentral

26.

Lanzieri CF, Som PM, Sacher M, Solodnik P, Moore F (1986) The postcraniectomy site: CT appearance. Radiology 159(1):165–170PubMedCrossRef

27.

Li LM, Kolias AG, Guilfoyle MR, Timofeev I, Corteen EA, Pickard JD et al (2012) Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Acta Neurochir (Wien) 154(9):1555–1561PubMedCrossRef

28.

Massaro F, Lanotte M, Faccani G, Triolo C (1996) One hundred and twenty-seven cases of acute subdural haematoma operated on. Correlation between CT scan findings and outcome. Acta Neurochir (Wien) 138(2):185–91PubMedCrossRef

29.

Nicolaides T, Nazemi KJ, Crawford J, Kilburn L, Minturn J, Gajjar A et al (2020) Phase I study of vemurafenib in children with recurrent or progressive BRAF(V600E) mutant brain tumors: Pacific Pediatric Neuro-Oncology Consortium study (PNOC-002). Oncotarget 11(21):1942–1952PubMedPubMedCentralCrossRef

30.

Paci GM, Sise MJ, Sise CB, Sack DI, Shackford SR, Kureshi SA et al (2009) Preemptive craniectomy with craniotomy: what role in the management of severe traumatic brain injury? J Trauma 67(3):531–536PubMed

31.

Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB, Sheik-Ali S et al (2017) Craniotomy versus decompressive craniectomy for acute subdural hematoma: systematic review and meta-analysis. World Neurosurg 101:677–85.e2PubMedCrossRef

32.

Ruggeri AG, Cappelletti M, Tempestilli M, Fazzolari B, Delfini R (2022) Surgical management of acute subdural hematoma: a comparison between decompressive craniectomy and craniotomy on patients treated from 2010 to the present in a single center. J Neurosurg Sci 66(1):22–27PubMedCrossRef

33.

Rush B, Rousseau J, Sekhon MS, Griesdale DE (2016) Craniotomy versus craniectomy for acute traumatic subdural hematoma in the United States: a national retrospective cohort analysis. World Neurosurg 88:25–31PubMedCrossRef

34.

Sawauchi S, Abe T (2008) The effect of haematoma, brain injury, and secondary insult on brain swelling in traumatic acute subdural haemorrhage. Acta Neurochir (Wien) 150(6):531–6 discussion 6PubMedCrossRef

35.

Sawauchi S, Murakami S, Ogawa T, Abe T (2007) Acute subdural hematoma associated with diffuse brain injury: analysis of 526 cases in Japan neurotrauma data bank. No Shinkei Geka 35(1):43–51PubMed

36.

Seifman MA, Lewis PM, Rosenfeld JV, Hwang PY (2011) Postoperative intracranial haemorrhage: a review. Neurosurg Rev 34(4):393–407PubMedCrossRef

37.

Sinclair AG, Scoffings DJ (2010) Imaging of the post-operative cranium. Radiographics 30(2):461–482PubMedCrossRef

38.

Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB (2008) The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Can J Surg 51(5):339–345PubMedPubMedCentral

39.

Tsermoulas G, Shah O, Wijesinghe HE, Silva AHD, Ramalingam SK, Belli A (2016) Surgery for acute subdural hematoma: replace or remove the bone flap? World Neurosurg 88:569–575PubMedCrossRef

40.

van Essen TA, van Erp IAM, Lingsma HF, Pisică D, Yue JK, Singh RD et al (2023) Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study. eClinicalMedicine 63:102161PubMedPubMedCentralCrossRef

41.

Waqas M, Shamim MS, Enam SF, Qadeer M, Bakhshi SK, Patoli I et al (2016) Predicting outcomes of decompressive Craniectomy: use of Rotterdam computed tomography classification and Marshall classification. Br J Neurosurg 30(2):258–263PubMedCrossRef

42.

Woertgen C, Rothoerl RD, Schebesch KM, Albert R (2006) Comparison of craniotomy and craniectomy in patients with acute subdural haematoma. J Clin Neurosci 13(7):718–721PubMedCrossRef

43.

Wong GK, Hung YW, Chong C, Yeung J, Chi-Ping Ng S, Rainer T et al (2010) Assessing the neurological outcome of traumatic acute subdural hematoma patients with and without primary decompressive craniectomies. Acta Neurochir Suppl 106:235–237PubMedCrossRef

Title: Surgical strategies in acute subdural hematoma: a meta-analysis of decompressive craniectomy vs. craniotomy
Authors: Muhammad Ashir Shafique
Muhammad Saqlain Mustafa
Brandon Luke-Wold
Aashish Kumar
Burhanuddin Sohail Rangwala
Muhammad Abdullah
Syed Muhammad Sinaan Ali
Javed Iqbal
Abdul Haseeb
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Craniotomy
Subdural Hematoma
Central Nervous System Trauma
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-06013-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical strategies in acute subdural hematoma: a meta-analysis of decompressive craniectomy vs. craniotomy

Abstract

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Is radiomics a useful addition to magnetic resonance imaging in the preoperative classification of PitNETs?

Retraction Note: 6-Mercaptopurine reverses experimental vasospasm and alleviates the production of endothelins in NO-independent mechanism—a laboratory study

An update on tests used for intraoperative monitoring of cognition during awake craniotomy

Beyond fluorescence-guided resection: 5-ALA-based glioblastoma therapies

Reply to: “On the use of flexible endoscopes to aspirate intraventricular hemorrhage, off label innovations, and regulations”

Intracranial–intracranial bypass strategies for the treatment of complex intracranial aneurysms: anatomical characteristics and surgical intervention