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Neurosurgical Review

Open Access 01-12-2024 | General Anesthesia | Review

Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis

Authors: Mariam Ahmed Abdelhady, Ahmed Aljabali, Mohammad Al-Jafari, Ibrahim Serag, Amr Elrosasy, Ahmed Atia, Aya Ehab, Shrouk F. Mohammed, Ibraheem M. Alkhawaldeh, Mohamed Abouzid

Published in: Neurosurgical Review | Issue 1/2024

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Abstract

Background

Surgery is the primary treatment for chronic subdural hematoma, and anesthesia significantly impacts the surgery's outcomes. A previous systematic review compared general anesthesia to local anesthesia in 319 patients. Our study builds upon this research, analyzing 4,367 cases to provide updated and rigorous evidence.

Methods

We systematically searched five electronic databases: PubMed, Cochrane Library, Scopus, Ovid Medline, and Web of Science, to identify eligible comparative studies. All studies published until September 2023 were included in our analysis. We compared six primary outcomes between the two groups using Review Manager Software.

Results

Eighteen studies involving a total of 4,367 participants were included in the meta-analysis. The analysis revealed no significant difference between the two techniques in terms of 'recurrence rate' (OR = 0.95, 95% CI [0.78 to 1.15], P = 0.59), 'mortality rate' (OR = 1.02, 95% CI [0.55 to 1.88], P = 0.96), and 'reoperation rate' (OR = 0.95, 95% CI [0.5 to 1.79], P = 0.87). Local anesthesia demonstrated superiority with a lower 'complications rate' than general anesthesia, as the latter had almost 2.4 times higher odds of experiencing complications (OR = 2.4, 95% CI [1.81 to 3.17], P < 0.00001). Additionally, local anesthesia was associated with a shorter 'length of hospital stay' (SMD = 1.19, 95% CI [1.06 to 1.32], P < 0.00001) and a reduced 'duration of surgery' (SMD = 0.94, 95% CI [0.67 to 1.2], P < 0.00001).

Conclusion

Surgery for chronic subdural hematoma under local anesthesia results in fewer complications, a shorter length of hospital stay, and a shorter duration of the operation.
Literature
1.
Balser D, Farooq S, Mehmood T, Reyes M, Samadani U (2015) Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg 123:1209–1215CrossRefPubMedPubMedCentral
2.
Feghali J, Yang W, Huang J (2020) Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment, and Outcome. World Neurosurg 141:339–345CrossRefPubMed
3.
Toi H, Kinoshita K, Hirai S, Takai H, Hara K, Matsushita N et al (2018) Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database. J Neurosurg 128:222–228CrossRefPubMed
4.
Takahashi K, Mima T, Akiba Y (2016) Chronic Subdural Hematoma Associated with Spontaneous Intracranial Hypotension: Therapeutic Strategies and Outcomes of 55 Cases. Neurol Med Chir (Tokyo) 56:69–76CrossRefPubMed
5.
6.
7.
Wang C, Liu C (2023) Surgical treatment of chronic subdural hematoma by twist drill craniotomy: A 9-year, single-center experience of 219 cases. Clin Neurol Neurosurg 232:107891CrossRefPubMed
8.
Holl DC, Volovici V, Dirven CMF, Peul WC, van Kooten F, Jellema K et al (2018) Pathophysiology and Nonsurgical Treatment of Chronic Subdural Hematoma: From Past to Present to Future. World Neurosurg 116:402-411.e2CrossRefPubMed
9.
Aljabali A, Serag I, Diab S, Alhadeethi AZ, Abdelhady M, Alkhawaldeh IM, Abouzid M (2024) Irrigation versus no irrigation in the treatment of chronic subdural hematoma: An updated systematic review and meta-analysis of 1581 patients. Neurosurg Rev 47(1):130. https://​doi.​org/​10.​1007/​s10143-024-02368-2
10.
Aljabali A, Sharkawy AM, Jaradat B, Serag I, Al-dardery NM, Abdelhady M et al (2023) Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients. Neurosurg Rev 46:251CrossRefPubMedPubMedCentral
11.
Bishnoi V, Kumar B, Bhagat H, Salunke P, Bishnoi S (2016) Comparison of Dexmedetomidine Versus Midazolam-Fentanyl Combination for Monitored Anesthesia Care During Burr-Hole Surgery for Chronic Subdural Hematoma. J Neurosurg Anesthesiol 28:141–146CrossRefPubMed
12.
Surve RM, Bansal S, Reddy M, Philip M (2017) Use of Dexmedetomidine Along With Local Infiltration Versus General Anesthesia for Burr Hole and Evacuation of Chronic Subdural Hematoma (CSDH). J Neurosurg Anesthesiol 29:274–280CrossRefPubMed
13.
Wang W, Feng L, Bai F, Zhang Z, Zhao Y, Ren C (2016) The Safety and Efficacy of Dexmedetomidine vs. Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial. Front Pharmacol 7:410CrossRefPubMedPubMedCentral
14.
Xu X-P, Liu C, Wu Q (2014) Monitored anesthesia care with dexmedetomidine for chronic subdural hematoma surgery. J Neurosurg Anesthesiol 26:408–409CrossRefPubMed
15.
Hestin R, Kamga Totouom H, Gaberel T, Parienti JJ, Hanouz JL (2022) Time to medical fitness for discharge following surgical evacuation of chronic subdural haematoma with general or regional anaesthesia: a prospective randomised trial. Anaesthesia 77:547–554CrossRefPubMed
16.
Liu H-Y, Yang L-L, Dai X-Y, Li Z-P (2022) Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 26:1625–1631PubMed
17.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71CrossRefPubMedPubMedCentral
18.
19.
Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135CrossRefPubMedPubMedCentral
20.
21.
Terrin N, Schmid CH, Lau J, Olkin I (2003) Adjusting for publication bias in the presence of heterogeneity. Stat Med 22:2113–2126CrossRefPubMed
22.
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMed
23.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898CrossRefPubMed
24.
Alnaami I, Aseeri AM, Albinali A, Dlboh S, Alqahtani A, Awadalla NJ (2021) Surgery of chronic subdural hematoma under local anesthesia and its association with recurrence: A single tertiary care center experience. Interdiscip Neurosurg 26:101293CrossRef
25.
Blaauw J, Jacobs B, Hertog HM den, Gaag NA van der, Jellema K, Dammers R, et al. (2020) Neurosurgical and perioperative management of chronic subdural hematoma. Front Neurol 11
26.
Chen FM, Wang K, Xu KL, Wang L, Zhan TX, Cheng F et al (2020) Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage. BMC Neurol 20:92CrossRefPubMedPubMedCentral
27.
28.
Gelabert-González M, Arán-Echabe E, Bandín-Diéguez FJ, Santín-Amo JM, Serramito-García R, Prieto-González Á et al (2016) Bilateral chronic subdural haematoma: Analysis of a series of 190 patients. Neurocir Astur Spain 27:103–11CrossRef
29.
Han M-H, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi H-J (2017) Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg 127:1117–1125CrossRefPubMed
30.
Iftikhar M, Siddiqui UT, Rauf MY, Malik AO, Javed G (2016) Comparison of Irrigation versus No Irrigation during Burr Hole Evacuation of Chronic Subdural Hematoma. J Neurol Surg Part Cent Eur Neurosurg 77:416–421CrossRef
31.
Katsuki M, Kakizawa Y, Wada N, Yamamoto Y, Uchiyama T, Nakamura T et al (2020) Endoscopically Observed Outer Membrane Color of Chronic Subdural Hematoma and Histopathological Staging: White as a Risk Factor for Recurrence. Neurol Med Chir (Tokyo) 60:126–135CrossRefPubMed
32.
Fountas K, Kotlia P, Panagiotopoulos V, Fotakopoulos G (2019) The outcome after surgical vs nonsurgical treatment of chronic subdural hematoma with dexamethasone. Interdiscip Neurosurg 16:70–74CrossRef
33.
Mahmood SD, Waqas M, Baig MZ, Darbar A (2017) Mini-Craniotomy Under Local Anesthesia for Chronic Subdural Hematoma: An Effective Choice for Elderly Patients and for Patients in a Resource-Strained Environment. World Neurosurg 106:676–679CrossRefPubMed
34.
Shen J, Xin W, Li Q, Gao Y, Zhang J (2019) A Grading System For The Prediction Of Unilateral Chronic Subdural Hematoma Recurrence After Initial Single Burr Hole Evacuation. Risk Manag Healthc Policy 12:179–188CrossRefPubMedPubMedCentral
35.
Shen J, Yuan L, Ge R, Wang Q, Zhou W, Jiang XC et al (2019) Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study. Injury 50:1634–1640CrossRefPubMed
36.
Wong HM, Woo XL, Goh CH, Chee PHC, Adenan AH, Tan PCS et al (2022) Chronic Subdural Hematoma Drainage Under Local Anesthesia with Sedation versus General Anesthesia and Its Outcome. World Neurosurg 157:e276–e285CrossRefPubMed
37.
Zhuang Z, Chen Z, Chen H, Chen B, Zhou J, Liu A et al (2022) Using Local Anesthesia for Burr Hole Surgery of Chronic Subdural Hematoma Reduces Postoperative Complications, Length of Stay, and Hospitalization Cost: A Retrospective Cohort Study From a Single Center. Front Surg 9:783885CrossRefPubMedPubMedCentral
38.
Ashry A, Al-Shami H, Gamal M, Salah AM (2022) Local anesthesia versus general anesthesia for evacuation of chronic subdural hematoma in elderly patients above 70 years old. Surg Neurol Int 13:13CrossRefPubMedPubMedCentral
39.
Santarius T, Qureshi HU, Sivakumaran R, Kirkpatrick PJ, Kirollos RW, Hutchinson PJ (2010) The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma. World Neurosurg 73:747–750CrossRefPubMed
40.
Chon K-H, Lee J-M, Koh E-J, Choi H-Y (2012) Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 154:1541–1548CrossRefPubMed
41.
Yadav YR, Parihar V, Namdev H, Bajaj J (2016) Chronic subdural hematoma. Asian. J Neurosurg 11:330–342
42.
Karcz M, Papadakos PJ (2013) Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther CJRT Rev Can Thérapie Respir RCTR 49:21–29
43.
44.
Mariam Abdelhady, Ibrahim Serag, Ibraheem Alkhawaldeh, Ahmed Aljabali, Mohammad Al-Jafari, Amr Elrosasy, Aya Ehab, Ahmed Atia, Shrouk Fawze Mohammed, Mohamed Abouzid, Ahmed Negida (2024) Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis (P7-11.017) Neurology 102(17_supplement_1) 10.1212/WNL.0000000000205006
Metadata
Title
Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis
Authors
Mariam Ahmed Abdelhady
Ahmed Aljabali
Mohammad Al-Jafari
Ibrahim Serag
Amr Elrosasy
Ahmed Atia
Aya Ehab
Shrouk F. Mohammed
Ibraheem M. Alkhawaldeh
Mohamed Abouzid
Publication date
01-12-2024
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 1/2024
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-024-02420-1