Endoscope-Assisted Surgery vs. Burr-Hole Craniostomy for the Treatment of Chronic Subdural Hematoma: A Systemic Review and Meta-Analysis

Abstract

Objectives: This article aims to evaluate the safety and effectiveness of endoscope-assisted surgery for chronic subdural hematoma (cSDH) in comparison with the burr-hole craniostomy. Methods: An electronic literature research was performed in MEDLINE, the Cochrane library, and EMBASE from the inception to February 18, 2020. A systematic review with meta-analyses was conducted to compare the efficacy of endoscope-assisted surgery with Burr-hole Craniostomy (BHC) surgery. Results: This meta-analysis included four studies comprising 441 patients. Endoscope-assisted surgery significantly decreased the risk of recurrence in patients with cSDH [odds ratio, 0.368; 95% confidence interval (CI), 0.178-0.759; P = 0.007; I 2 = 0%]. The complication rate was also significantly lower in the endoscope-assisted group (OR, 0.249; 95% CI, 0.07-0.882; P = 0.031; I 2 = 71.87%). Conclusion: We conducted the first meta-analysis of endoscope-assisted surgery for cSDH. The meta-analysis of four studies comprising 441 patients with cSDH suggests a significantly decreased risk of recurrence and postoperative complications after endoscope-assisted surgery. Therefore, endoscope-assisted surgery is effective and safe in treating cSDH.

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses

“…Burr-hole irrigation and drainage performed via endoscopy may be a suitable option, as recommended by previous research. 41 The use of a neuroendoscope can facilitate the safe removal of clots, residual septa, and trabecula structures as well as the coagulation of bleeding source in the hematoma cavity via direct visualization to promote brain expansion. 42 Moreover, the device could be used to identify the color of the outer membrane of the hematoma capsule, which is classification of may connection with the histopathological classification of CSDH.…”

Rigid Neuroendoscopy Assisted Hematoma Resection Reduces the Recurrence Rate of Chronic Subdural Hematoma With Mixed Density: A Retrospective Analytic Cohort Study

“…But for patients with symptoms of brain compression, surgical treatment is the most effective and widely-used therapy for CSDH, including twist-drill craniostomy, BHC, and craniotomy (6). Although most cases of CSDH resolve after BHC, its recurrence remains a problem (7). With the development of endoscopic neurosurgical techniques, the application of rigid neuroendoscopy in the treatment of CSDH has shown unique advantages and satisfactory efficacy over recent years (8).…”

Endoscope-Assisted Manipulation of Chronic Subdural Hematoma Provide a Novel Solution for Eliminating Septum and Inner Membrane Leading to Reducing Recurrence

“…It is about ve times among elder than 65 years of CSDHs than younger [1,13]. In Asia, CSDH are typically caused by minor head trauma about fty percent, male predominant, occurring at age above 65 years old [7]. Two common mechanisms have been proposed by which blood or uid can accumulate within the dura cell layer in the border.…”

“…The most complicating situation leading to post-surgical recurrence after BHC-D is the separation or compartmentalization of SDH spaces of different time-episodes. Frequently, symptomatic CSDH demands urgent neurosurgical management and there are several treatment strategies for CSDH accordingly, such as twist drill craniostomy, traditional craniotomy and BHC-D [7]. Among them, BHC-D has been the mainstream for neurosurgical treatment of CSDH.…”