Craniotomy versus decompressive craniectomy for acute subdural hematoma: systematic review and meta-analysis.

World Neurosurg. 2017 Mar 15. pii: S1878-8750(17)30336-4. doi: 10.1016/j.wneu.2017.03.024. [Epub ahead of print]

Craniotomy versus decompressive craniectomy for acute subdural hematoma: systematic review and meta-analysis.



Acute subdural hematoma (SDH) is a major cause of morbidity following severe traumatic brain injury. Surgical evacuation of the hematoma, either via craniotomy or craniectomy, is the mainstay of treatment in patients with progressive neurological deficits or significant mass effect. However, the decision between either procedure remains controversial.


A literature search using major online databases and a manual search of reference on the topic of craniotomy and craniectomy for evacuation of subdural hematoma until September 2016 was performed. The outcome variables were analyzed which included residual SDH, revision rate, and clinical outcome.


Six comparison studies, with a total number of 2006 craniotomy and 451 craniectomy patients, fulfilled the inclusion criteria. Patients who underwent craniectomy scored significantly lower on the Glasgow Coma Scale at the time of initial presentation. Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group compared to the craniotomy group (p = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1% vs 60.1%, p = 0.004). Similarly, mortality rates was lower in the craniotomy group compared to craniectomy (p = 0.004).


The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SD remain controversial. In the current study, craniectomy was associated with worse clinical presentation and postoperative outcome compared to craniotomy. However, craniectomy was associated with lower rate of residual SDH following treatment.


craniectomy; craniotomy; decompression; subdural hematoma; traumatic brain injury



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