Unilateral or bilateral drainage for patients with bilateral chronic subdural hematoma: a systematic review and retrospective cohort study
Abstract
Bilateral chronic subdural hematoma (cSDH) can be treated with unilateral or bilateral drainage. Unilateral drainage reduces surgery-related risks but could entail growth of the contralateral, non-operated hematoma. This study aims to (1) determine the incidence of additional contralateral surgery, (2) find factors associated with its occurrence, and (3) evaluate outcomes of uni- and bilateral drainage in bilateral cSDH patients. A systematic review (SR) conducted according to the PRISMA guidelines, pooled incidences of additional contralateral surgery with 95% confidence intervals (CI). Meta-analyses explored factors associated with contralateral surgery. Subsequently, a single-center, retrospective cohort study of bilateral cSDH patients treated with burr hole craniostomy (2010–2022) was performed. The primary outcome was occurrence of additional, contralateral surgery after unilateral drainage. Additionally, surgical complications, 30-day mortality, and reoperation rates (ipsilateral recurrence and additional contralateral surgery) were compared for unilateral and bilateral approaches in all patients and in two subgroups: cases with clinical equipoise regarding surgical approach and a propensity score-matched cohort. The pooled incidence of additional contralateral surgery in 697 patients (SR: 630, cohort: 67) receiving unilateral surgery was 14% (95% CI: 9–19%). Smaller ipsilateral hematoma (mean difference (MD): 12.2 ml, 95% CI: 7.18–17.23) and larger contralateral…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 697 participants or records.
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