TY - JOUR
T1 - Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma
T2 - a systematic review and meta-analysis
AU - Yagnik, Karan J.
AU - Goyal, Anshit
AU - Van Gompel, Jamie J.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
PY - 2021/12
Y1 - 2021/12
N2 - Introduction: There is a clinical equipoise between burr hole drainage (BHD) or twist drill craniotomy (TDC) as initial surgical intervention in patients with chronic subdural hematoma (cSDH). Moreover, the impact of type of postoperative drainage is not well elucidated. We performed a systematic review and meta-analysis comparing outcomes following BHD and TDC for initial surgical management in cSDH and to understand the impact of negative suction drainage with TDC. Methods: A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that directly compared TDC and BHD. The following outcomes were compared between TDC and BHD: mortality, recurrence, reoperations, complications, and cure rates. Subgroup analysis was performed to determine impact of negative suction drainage with TDC. Results: Sixteen articles (n = 1,235; TDC: 663; BHD: 591) met inclusion criteria. Although complications (OR: 0.68, 95% CI: 0.38–1.23, p = 0.21; I2 = 31%), recurrence (OR: 1.16, 95% CI: 0.84–1.62, p = 0.37; I2 = 28%), cure (OR: 1.11, 95% CI: 0.72–1.72, p = 0.64, I2 = 34%), and mortality rates (OR: 1.20, 95% CI: 0.60–2.41; p = 0.61; I2 = 0%) were not significantly different between the two groups, TDC was associated with a higher reoperations than BHD (OR: 1.48, 95% CI:1.01–2.16, p = 0.04; I2 = 41%). Subgroup analysis demonstrated that TDC with negative suction drainage conferred equivalent reoperation rates as BHD (OR: 0.75, 95% CI: 0.24–2.35; p = 0.62; I2 = 65%); however, TDC without negative suction was associated with higher reoperations (OR: 1.62, 95% CI: 1.08–2.42; p = 0.02; I2 = 40%). Conclusion: A systematic review and meta-analysis of available literature directly comparing TDC and BHD for primary evacuation of cSDH did not demonstrate clear superiority of either technique, although reoperations may be higher following TDC. Use of negative suction drainage with TDC may lead to similar rates of reoperation as BHD.
AB - Introduction: There is a clinical equipoise between burr hole drainage (BHD) or twist drill craniotomy (TDC) as initial surgical intervention in patients with chronic subdural hematoma (cSDH). Moreover, the impact of type of postoperative drainage is not well elucidated. We performed a systematic review and meta-analysis comparing outcomes following BHD and TDC for initial surgical management in cSDH and to understand the impact of negative suction drainage with TDC. Methods: A literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies that directly compared TDC and BHD. The following outcomes were compared between TDC and BHD: mortality, recurrence, reoperations, complications, and cure rates. Subgroup analysis was performed to determine impact of negative suction drainage with TDC. Results: Sixteen articles (n = 1,235; TDC: 663; BHD: 591) met inclusion criteria. Although complications (OR: 0.68, 95% CI: 0.38–1.23, p = 0.21; I2 = 31%), recurrence (OR: 1.16, 95% CI: 0.84–1.62, p = 0.37; I2 = 28%), cure (OR: 1.11, 95% CI: 0.72–1.72, p = 0.64, I2 = 34%), and mortality rates (OR: 1.20, 95% CI: 0.60–2.41; p = 0.61; I2 = 0%) were not significantly different between the two groups, TDC was associated with a higher reoperations than BHD (OR: 1.48, 95% CI:1.01–2.16, p = 0.04; I2 = 41%). Subgroup analysis demonstrated that TDC with negative suction drainage conferred equivalent reoperation rates as BHD (OR: 0.75, 95% CI: 0.24–2.35; p = 0.62; I2 = 65%); however, TDC without negative suction was associated with higher reoperations (OR: 1.62, 95% CI: 1.08–2.42; p = 0.02; I2 = 40%). Conclusion: A systematic review and meta-analysis of available literature directly comparing TDC and BHD for primary evacuation of cSDH did not demonstrate clear superiority of either technique, although reoperations may be higher following TDC. Use of negative suction drainage with TDC may lead to similar rates of reoperation as BHD.
KW - Burr hole
KW - Chronic subdural hematoma
KW - Craniotomy
KW - Literature review
KW - Subdural drainage
KW - Twist drill
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U2 - 10.1007/s00701-021-05019-3
DO - 10.1007/s00701-021-05019-3
M3 - Article
C2 - 34647183
AN - SCOPUS:85117134814
SN - 0001-6268
VL - 163
SP - 3229
EP - 3241
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 12
ER -