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Review
. 2017 Aug:104:418-429.
doi: 10.1016/j.wneu.2017.05.030. Epub 2017 May 13.

Membranectomy in Chronic Subdural Hematoma: Meta-Analysis

Ronald Sahyouni  1 , Hossein Mahboubi  2 , Peter Tran  3 , John S Roufail  3 , Jefferson W Chen  4
Affiliations
Review

Membranectomy in Chronic Subdural Hematoma: Meta-Analysis

Ronald Sahyouni et al. World Neurosurg. 2017 Aug.

Abstract

Objective: Initial management strategies of chronic subdural hematoma (cSDH) are controversial and range from bedside twist-drill or burr-hole drainage to craniotomy with membranectomy (CWM). We aim to 1) perform a meta-analysis of the available data on the outcomes of CWM for treatment of cSDH in published English-language literature and 2) evaluate collective outcomes of CWM with respect to morbidity, mortality, and recurrence rates.

Methods: A search of English-language literature performed in PubMed, Ovid, and Cochrane databases using key words ("subdural hematoma" or "chronic subdural hematoma") and ("membrane" or "membranectomy") from inception to December 2016 was conducted. Studies reporting outcomes of CWM in cSDH were included. Mortality, morbidity, follow-up duration, and recurrence rate data were extracted and analyzed. Pooled estimates and confidence intervals (CIs) were calculated for all outcomes using a random-effects model.

Results: Of 301 articles found, 17 articles containing 5369 patients met our eligibility criteria. Mean follow-up duration ranged from 1-30.8 months. Collective mean mortality and morbidity rates were 3.7% and 6.9%, respectively (95% CI 2-5.4% and 2.1-11.6%; P < 0.001 and P = 0.004). The collective mean recurrence rate was 7.6% (95% CI: 5%-10.2%; P < 0.001).

Conclusions: Clinical data on outcomes of CWM in cSDH are limited to single institutional analyses, with considerable variation in recurrence rates and follow-up time. The rates we reported are comparable with the 5% mortality and 3%-12% morbidity rates and lower than the 10%-21% recurrence rate in the literature for burr holes or craniotomy without membranectomy. This meta-analysis provides an in-depth analysis of available data and reviews reported outcomes.

Keywords: Craniotomy; Membranectomy; Neurosurgery; Subdural hematoma; Traumatic brain injury.

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Conflict of interest statement

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Figure 1
Figure 1
Flow diagram of study selection. *12 studies were included in the quantitative analysis of recurrence rates, 8 studies were included in the quantitative analysis of morbidity rates, and 14 studies were included in the quantitative analysis of mortality rates.
Figure 2
Figure 2
Forest plot demonstrating a 3.7% overall mortality rate with each line representing the 95% confidence interval. Boxes represent mortality rates in that study with its size correlating to the study’s effect size.
Figure 3
Figure 3
Forest plot demonstrating a 6.9% overall morbidity rate with each line representing the 95% confidence interval. Boxes represent morbidity rates in that study with its size correlating to the study’s effect size.
Figure 4
Figure 4
Forest plot demonstrating a 7.6% overall recurrence rate with each line representing the 95% confidence interval. Boxes represent recurrence rates in that study with its size correlating to the study’s effect size.
Figure 5
Figure 5
Decision tree for the type of chronic subdural hematoma (cSDH) evacuation once surgical treatment has been deemed necessary.
See this image and copyright information in PMC

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