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. 2023 Sep 15:14:1249332.
doi: 10.3389/fneur.2023.1249332. eCollection 2023.

Success of conservative therapy for chronic subdural hematoma patients: a systematic review

M Foppen  1   2 , Harssh Verdan Bandral  1   2 , Kari-Anne Mariam Slot  1   2 , W P Vandertop  1   2 , D Verbaan  1   2
Affiliations

Success of conservative therapy for chronic subdural hematoma patients: a systematic review

M Foppen et al. Front Neurol. .

Abstract

Background: Conservative therapy for chronic subdural hematoma (cSDH) is an option for patients who express no, or only mild symptoms, thereby preventing surgery in some. Because it is not clear for whom conservative therapy is successful, we aimed to estimate the success rate of conservative therapy and to identify which factors might influence success.

Methods: We systematically searched MEDLINE and EMBASE databases to identify all available publications reporting outcome of conservative therapy for cSDH patients. Studies containing >10 patients were included. The primary outcome was the success rate of conservative therapy, defined as "no crossover to surgery" during follow-up. In addition, factors possibly associated with success of conservative therapy were explored. Bias assessment was performed with the Newcastle Ottowa Scale and the Cochrane risk-of-bias tool. We calculated pooled incidence and mean estimates, along with their 95% confidence intervals (CIs), using OpenMeta[Analyst] software.

Results: The search yielded 1,570 articles, of which 11 were included in this study, describing 1,019 conservatively treated patients. The pooled success rate of conservative therapy was 66% (95% CI: 50-82%). One study (n = 98) reported smaller hematoma volume to be associated with success, whilst another study (n = 53) reported low hematoma density and absence of paresis at diagnosis to be associated with success.

Conclusion: Conservative therapy is reported to be successful in the majority of cSDH patients who have either no, or only mild symptoms. Hematoma volume, low hematoma density and absence of paresis could be factors associated with success. However, further research is warranted in order to establish factors consistently associated with a successful conservative therapy.

Other: No funding was acquired for this study. The study was not registered nor was a study protocol prepared.

Keywords: chronic; hematoma; humans; incidence; risk factors; subdural; treatment outcome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection process (21). DC, decompressive craniectomy.
Figure 2
Figure 2
Risk of bias and quality assessment of randomized studies with the Risk of Bias 2.0.
See this image and copyright information in PMC

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