Description of the 250 eligible studiesdownload.lww.com/wolterskluwer_vitalstream_com/PermaLink/SLA/A/SLA... · 1 Description of the 250 eligible studies Author/ Year Study Design

1

Description of the 250 eligible studies

Author/

Year

Study

Design

Quality Assessment

Study Population

Outcomes

Gomez Mendz1

(1971)

Retrospective

observational

study

Newcastle-Ottawa Scale:

Low

33 patients with chronic subdural

hematomas. Managed with

frontoparietal craniotomy.

Morbidity: 2 (epidural hematoma), 2

(subdural hematomas), 1

(osteomyelitis). Good recovery: 28.

Kak et al2

(1971)

Retrospective

observational study


Low

66 patients with 74 chronic subdural

hematomas. Managed with two burr holes craniostomy. 15 had drains.

Morbidity: 6. Good recovery: 6.

Recurrence rate: 3, managed with craniotomy and membranectomy.

Hirakawa et al3 (1972)

Retrospective observational

study

Newcastle-Ottawa Scale: High

309 patients with chronic subdural hematomas. 170 managed with

craniotomy and 133 with burr hole

craniostomy. 166 had irrigation.

Morbidity: 6. Good recovery: craniotomy: 104/114, burr hole:

84/89. Recurrence rate: craniotomy:

28, burr hole: 15.

Waga et al4

(1972)

Retrospective

observational

study


High


hematomas. 8 managed with

craniotomy and 20 with burr hole craniostomy.

Mortality: 0. Morbidity: 1 (epidural

hematoma). Good recovery: 23.

Recurrence rate: 2.

Bender et al5 (1974)


study


185 patients with chronic subdural hematomas. 75 managed medically,

88 surgically, and 22 with both. 37

had adjuvant corticosteroids and 60 had bed rest.

Mortality: 14. Good recovery: 162.

So et al6

(1977)

Retrospective

observational study


Low


hematomas. Managed with two burr hole craniostomy. 20 had irrigation

and 20 had bed rest.

Mortality: 2. Morbidity: 1

(pneumonia). Good recovery: 12. Recurrence rate: 5, managed with

retapping the subdural space. Second

recurrence: 2.

Tabaddor et al7

(1977)

Retrospective

observational study


High


hematomas. 21 managed with percutaneous twist drill drainage, 22

with burr hole craniostomy, and 28

with craniotomy with or without membranectomy. 21 had drains and

bed rest for 24 hours.

Mortality: percutaneous drainage: 2,

burr hole: 5, craniotomy: 8. Morbidity: 2 (stroke). Good recovery:

percutaneous drainage: 18, burr hole:

9, craniotomy: 11. Recurrence rate: percutaneous drainage: 1, burr hole:

3, craniotomy: 3.

Cameron8

(1978)

Retrospective

observational

study


High

114 patients with 127 chronic

subdural hematomas. 2 patients

used anticoagulants. 112 managed with two burr hole craniostomy and

2 with craniotomy. 112 had

irrigation.

Mortality: 5. Morbidity: 1 (infection

and subdural abscess), 3 (seizure), 1

(communicating hydrocephalus), 6 (increase in seizure frequencies).

Good recovery: 101. Recurrence rate:

3, managed with two burr holes.

Gilsbach et al9

(1980)

Retrospective

observational

study


Low


hematomas. Managed with burr

hole craniostomy. 51 had drains and irrigation.


Recurrence rate: 11.

Hubschmann10

(1980)

Prospective

observational

study


High



percutaneous twist drill drainage. 22

had drains for 24 hours with 0 bed rest.

Mortality: 5. Morbidity: 1 (sepsis), 2

(aspiration pneumonia and cardiac

arrest), 1 (fatal pulmonary embolism),

1 (massive basilar artery stroke), 2 (failure of procedure). Good

recovery: 15. Recurrence rate: 2,

managed with percutaneous drainage and craniotomy. Second recurrence:

0.

Arbit et al11 Retrospective Newcastle-Ottawa Scale: 25 patients with chronic subdural Morbidity: 0. Good recovery: 22.

2

(1981) observational

study

Low hematomas. 5 used anticoagulants.

Managed with burr hole craniostomy. 25 had implantable

drains.

Recurrence rate: 5, managed with

percutaneous needle. Second recurrence: 1.

Iwabuchi et al12 (1981)


study


60 patients with chronic subdural hematomas. Managed with burr

hole craniostomy. 60 had irrigation.

Morbidity: 0. Good recovery: 60. Recurrence rate: 0.

Markwalder et

al13 (1981)

Prospective

observational

study


High



hole craniostomy. 0 had adjuvant corticosteroids. 32 had drains for 48

hours and bed rest.

Mortality: 0. Morbidity: 0. Good

outcome: 31. Recurrence rate: 1,

managed with craniotomy and membranectomy. Second recurrence:

0.

Moringlane et al14 (1981)


study

Newcastle-Ottawa Scale: Low

31 patients with 41 chronic subdural hematomas. 30 managed with

enlarged burr hole craniostomy. 30

had drains and irrigation.

Mortality: 6. Morbidity: 1 (superficial intracerebral hematoma), 1 (subdural

empyema). Good recovery: 4.

Ohaegbulam15

(1981)

Retrospective

observational study


Low


hematomas. Managed with burr hole craniostomy. 132 had irrigation

and 0 had drains.


(postoperative seizure). Good recovery: 82. Recurrence rate: 0.

Victoratos et al16 (1981)

Prospective observational

study


20 patients with chronic subdural hematomas. 17 managed with burr

hole craniostomy and 3 conservatively. 1 patient had

adjuvant corticosteroids.

Mortality: 0. Good recovery: 20. Recurrence rate: 2, managed with

burr hole.

Izumi et al17 (1982)


study



hole craniostomy. 16 had drains.

Mortality: 0. Morbidity: 0. Good recovery: 16. Recurrence rate: 1.

Moussa et al18

(1982)

Retrospective

observational

study


High


hematomas. 16 managed with two

burr hole craniostomy and 8 with one burr hole. 24 had irrigation. 0

had drains and 0 had bed rest.


(fulminating bronchopneumonia).

Good recovery: 24. Recurrence rate: 0.

Kitami et al19 (1983)


study


22 patients with chronic subdural hematomas. Managed with


had drains for 72 hours.

Mortality: 0. Morbidity: 0. Good recovery: 22.

Weir20

(1983)

Retrospective

observational study


Low


hematomas. 69 managed with one burr hole craniostomy. 69 had

drains.

Mortality: 2. Morbidity: 1 (infection).

Recurrence: 8.

Aoki21 (1984)


study



percutaneous twist drill drainage. 15 had irrigation and 0 had drains.

Morbidity: 0. Good recovery: 17 (no irrigation), 14 (irrigation). Recurrence

rate: 7 (no irrigation), 1 (irrigation), 3 managed with subdural tapping and 5

with burr hole.

Eggert et al22

(1984)

Retrospective

observational

study


Low



hole craniostomy. 100 had closed

system drainage.


burr hole.

Li et al23

(1984)

Retrospective

observational study


Low


hematomas. 70 managed with craniotomy, 8 with burr hole

craniostomy, and 2 conservatively.


(intermittent attacks of seizure). Good recovery: 65/65. Recurrence rate: 3,

managed with craniotomy. Second

recurrence: 0.

Patrick et al24 Retrospective Newcastle-Ottawa Scale: 16 patients with chronic subdural Mortality: 1. Good recovery: 12.

3


study


15 managed with burr hole craniostomy, 1 managed

conservatively.

Richter et al25 (1984)


study


120 patients with 143 chronic subdural hematomas. 2 used

anticoagulants. 0 had adjuvant

corticosteroids. 120 managed with burr hole craniostomy. 120 had

irrigation and drainage with closed

system for 96 hours. 0 had bed rest.

Mortality: 5. Morbidity: 1 (deep intracerebral hemorrhage), 1 (cardiac

insufficiency and

bronchopneumonia), 3 (epidural hematoma). Good recovery: 114.

Recurrence rate: 2.

Robinson26

(1984)

Retrospective

observational study


High


subdural hematomas. 123 managed with burr hole craniostomy and 10

managed with craniotomy. 123 had

irrigation.

Mortality: 2. Morbidity: 1 (transient

hemiparesis), 1 (worsened consciousness), 24 (intracranial

hypotension), 20 (permanent

neurological disability), 1 (subdural infection), 1 (infected secondary bone

flap).

Kawakami et al27 (1985)


study


23 patients with chronic subdural hematomas. Managed with one burr


system drainage and 23 had irrigation.

Mortality: 1. Morbidity: 1 (left hemiplegia/intracerebral hematoma),

1 (tension pneumocephalus). Good

recovery: 21.

Markwalder et al28 (1985)


study


21 patients with chronic subdural hematomas. 1 used anticoagulants.

Managed with two burr hole

craniostomy. 0 had adjuvant corticosteroids. 21 had irrigation, 21

had bed rest for 24 hours, and 0 had

drains.


burr hole. Second recurrence: 1.

Camel et al29

(1986)

Retrospective

observational study


High


hematomas. Managed with percutaneous twist drill drainage.

114 had drains.

Mortality: 9. Morbidity: 1 (broken

catheter). Good recovery: 98. Recurrence rate: 12, 9 managed with

craniotomy and 3 with re-

trephination. Second recurrence: 2.

Markwalder et

al30 (1986)

Prospective

observational

study


High


hematomas. 26 used anticoagulants.

231 managed with burr hole craniostomy and 1 with craniotomy.

200 had closed system drainage,

irrigation, and bed rest.

Mortality: 5. Morbidity: 5 (subdural

empyema), 4 (neurological deficits

such as reflex asymmetry or mild hemiparesis), 1 (pulmonary

embolism), 1 (pneumonia). Good

recovery: 30/31. Recurrence rate: 9.

Aydin et al31

(1987)

Retrospective

observational study


Low


hematomas. Managed with burr hole craniostomy. 43 had closed

system drainage.

Mortality: 14.

Cheah et al32

(1987)

Retrospective

observational

study


Low


hematomas. 38 managed with one

burr hole craniostomy and 10 with two burr holes. 48 had drains and

irrigation.

Mortality: 0. Morbidity: 2 (minor

superficial infections), 1 (subdural

empyema). Good recovery: 39. Recurrence rate: 9, managed with

repeated aspiration. Second

recurrence: 0.

Kotwica et al33

(1987)

Retrospective

observational

study


Low


hematomas. 61 managed with burr

hole craniostomy and 29 with craniotomy and capsulectomy.

Mortality: burr hole: 1, craniotomy:

6.

Pichert et al34 (1987)


study


66 patients with chronic subdural hematomas. 13 managed surgically

and 53 medically with

corticosteroids and bed rest.

Good recovery: corticosteroids: 38/46. Recurrence rate:

corticosteroids: 8.

4

Yoshii et al35

(1987)

Retrospective

observational study


Low


hematomas. Managed with burr hole craniostomy. 68 had irrigation.


Chiang et al36

(1988)

Retrospective

observational study


Low


hematomas. Managed with one burr hole craniostomy. 23 had drains and

bed rest. 0 had irrigation.


recovery: 22. Recurrence rate: 1, managed with craniotomy and

capsulectomy. Second recurrence: 0.

Grisoli et al37

(1988)

Retrospective

observational

study


High



Managed with craniectomy. 100 had irrigation. 0 had adjuvant

corticosteroids.


(empyema), 3 (decubitus infection), 3

(seizure), 1 (partial motor deficit). Good recovery: 96. Recurrence rate:

2, managed with craniectomy. Second

recurrence: 0.

Hirai et al38

(1989)

Retrospective

observational

study


Low



burr holes and 13 conservatively. 226 had irrigation. 0 had drains.


Recurrence rate: burr hole: 24.

Iwadate et al39 (1989)


study




0 had drains.

Morbidity: 0. Recurrence rate: 1.

Laumer et al40

(1989)

Randomized

trial

See results of the Cochrane

risk of bias assessment tool


hematomas. Managed with one burr hole craniostomy. 48 had permanent

subdural drains with subcutaneous

reservoir, 49 had external closed system drainage, and 42 had no

drainage.

Morbidity: permanent drainage: 1

(infection), 2 (seizure), external drainage: 2 (infection), 1 (seizure), no

drainage: 1 (infection), 2 (seizure).

Recurrence rate: permanent drainage: 3, external drainage: 13, no drainage:

12, managed with burr hole.

Spallone et al41 (1989)


study


131 patients with 160 chronic subdural hematomas. Managed with

enlarged burr hole craniostomy. 131

had closed system drainage and irrigation.

Mortality: 4. Morbidity: 7 (systemic complications including pneumonia,

cardiac features, thrombophlebitis,

and urinary tract infection). Recurrence rate: 10.

Li42 (1990)


study


60 patients with chronic subdural hematomas. 59 managed with burr

hole craniostomy. 59 had drains and

irrigation.


Salomão et al43

(1990)

Retrospective

observational

study


Low



hole craniostomy.


Wakai et al44

(1990)

Prospective

observational study


High


hematomas. 0 used anticoagulants. Managed with one burr hole

craniostomy. 20 had closed system

drainage and 38 had irrigation.

Mortality: drainage: 3, no drainage: 1.

Morbidity: drainage: 1 (pneumonia), 1 (myocardial infarction), 1 (renal

failure). no drainage: 1 (pneumonia).

Good recovery: drainage: 16, no drainage: 10. Recurrence rate:

drainage: 1, no drainage: 6, managed

with re-irrigation. Second recurrence: 0.

Drapkin45 (1991)


study


53 patients with 56 chronic subdural hematomas. 5 used anticoagulants.


craniostomy. 53 had closed system drainage and irrigation.

Mortality: 3. Morbidity: 1 (post-operative sepsis and unilateral

subdural empyema), 1 (pneumonia), 1

(brainstem stroke), 2 (small intraparenchymatous bleeds in

cerebral hemispheres ipsilateral to

hematoma), 1 (superficial infection at burr hole site), 3 (post-operative

seizure). Good recovery: 41.


5

Kotwica et al46

(1991)

Retrospective

observational study


Low


hematomas. 0 used anticoagulants. Managed with two burr hole


drainage and irrigation.


(intracranial hypotension), 4 (cerebral edema), 3 (bronchopneumonia), 1

(intracerebral hematoma), 12

(hemiparesis or dementia), 9 (seizure). Good recovery: 108.

Recurrence rate: 3, managed with two

burr holes. Second recurrence: 0.

Rychlicki et

al47 (1991)

Retrospective

observational

study


Low



percutaneous twist drill drainage. 65 had closed system drainage and

irrigation.


(bronchopneumonic complication).

Good recovery: 65. Recurrence rate: 2, 1 managed with percutaneous

drainage and 1 with craniectomy.

Second recurrence: 1.

Ueno et al48

(1991)

Retrospective

observational study


Low


hematomas. Managed with one burr hole craniostomy. 64 had irrigation.

0 had drains.


recovery: 53. Recurrence rate: 0.

Vilalta et al49 (1991)


study




had closed system drainage. 0 had irrigation.

Mortality: 6. Recurrence rate: 12.

Aoki50 (1992)


study




had drains and 0 had irrigation.

Morbidity: 0. Good recovery: 40. Recurrence rate: 2, 1 managed with

percutaneous drainage and 1 with


Fu51

(1992)

Retrospective observational study


Low


hematomas. Managed with burr hole craniostomy. 95 had irrigation.

Morbidity: 5.

Adam et al52

(1993)

Retrospective

observational study


Low


hematomas. Managed with one burr hole craniostomy.

Mortality: 12. Morbidity: 2 (seizure),

12 (bronchopneumonia), 2 (myocardial infarction), 1 (acute

abdomen). Good recovery: 38.

Recurrence rate: 4.

Aoki et al53

(1993)

Retrospective

observational study


Low


hematomas. Managed with percutaneous twist drill drainage. 20

had drainage. 0 had irrigation.


recovery: 20.

Chung et al54 (1993)


study



hole craniostomy. 97 had drainage.

Mortality: 4. Cure rate: 65.

Hamilton et al55

(1993)

Retrospective

observational

study


High


subdural hematomas. 7 used

anticoagulants. 49 managed with craniotomy and 43 with burr hole

craniostomy. 49 had drains.

Mortality: craniotomy: 2, burr hole:

2. Morbidity: craniotomy: wound

infection (2 without drainage, 1 with drainage), other infection (1 without

drainage), other systemic

complications (3 without drainage, 1 with drainage), burr hole: wound

infection (1 without drainage), other

infection (3 with drainage), other systemic complications (1 without

drainage, 1 with drainage). Good

recovery: 47. Recurrence rate: craniotomy: 4 (without drainage), 1

(with drainage), burr hole: 0 (without

drainage), 3 (with drainage).

Ram et al56

(1993)

Randomized

trial





Mortality: 0. Morbidity: with

irrigation: 1 (occipital infarct), 1

6


craniostomy. 37 had drains for 48 hours and 19 had irrigation.

(transient deterioration of

consciousness with hemiparesis), without irrigation: 1 (tension

pneumocephalus), 1 (cortical

contusion), 1 (subdural empyema), 1 (superficial wound infection). Good

recovery: 37. Recurrence rate: 1 with

irrigation, 4 without irrigation, managed with two burr holes. Second

recurrence: 0.

Benzel et al57 (1994)


study



hole craniostomy. 111 had

irrigation. 0 had drains.

Mortality: 4. Morbidity: 2 (sepsis), 2 (myocardial infarction/pulmonary

embolus), 1 (symptomatic tension

pneumocephalus). Good recovery: 100. Recurrence rate: 12, managed

with burr hole. Second recurrence: 7.

Choudhury58

(1994)

Prospective

observational

study


High



Managed with two burr hole craniostomy. 44 had drains,


Mortality: 0. Morbidity: 1 (cerebral

edema), 1 (new contralateral

hematoma). Good recovery: 43. Recurrence rate: 1, managed with


Weisse et al59 (1994)


study



78 managed with two burr hole craniostomy and 28 with

craniectomy. 78 had drains for 48

hours, irrigation, and bed rest.

Mortality: burr hole: 4, craniotomy: 5. Morbidity: burr hole: 5 (post-

operative hemorrhage), 1 (wound infection), 1 (subdural empyema).

Good recovery: burr hole: 66,

craniotomy: 15. Recurrence rate: burr hole: 8.

Kitakami et al60

(1995)

Prospective

observational study


High


hematomas. Managed with one burr hole craniostomy. 19 had irrigation.

0 had drains and 0 had bed rest.



Krupp et al61

(1995)

Retrospective

observational

study


High



Managed with burr hole craniostomy. 212 had irrigation,

drains, and bed rest.

Mortality: 9. Morbidity: 5 (infection

of the wound), 2 (further developed

subdural empyema), 2 (thrombosis in the leg), 1 (pneumonia), 1

(pulmonary edema). Good recovery:

192. Recurrence rate: 53, managed with burr hole. Second recurrence: 7.

Merlicco et al62

(1995)

Prospective

observational study


High


hematomas. 3 used anticoagulants. Managed with small parietal

craniectomy.70 had drains and

irrigation.


pneumocephalus), 1 (heart failure with pulmonary edema). Good


Sabo et al63

(1995)

Retrospective

observational study


High


hematomas. 85 managed with burr hole craniostomy and 13 with

percutaneous twist drill drainage.


(respiratory complication), 3 (increased seizure frequency), 17

(new seizure activity). Good

recovery: 58/85. Recurrence rate: burr hole: 5, percutaneous drainage: 4.

Stroobandt et

al64 (1995)


study


Low



anticoagulants. Managed with one

burr hole craniostomy. 24 had adjuvant corticosteroids. 100 had

drains.



managed with one burr hole. Second

recurrence: 14.

Bhatty et al65 (1996)


study


100 patients with 118 chronic subdural hematomas. 84 managed

with percutaneous twist drill

drainage, 9 with two burr hole

Good recovery: percutaneous drainage: 55, craniotomy: 8.

Recurrence rate: percutaneous

drainage: 26, craniotomy: 0, managed

7

craniostomy, 8 with craniotomy,

and 17 conservatively. 84 had irrigation. 0 had drains.

with percutaneous drainage.

Mellergård et

al66 (1996)

Retrospective

observational study


High


subdural hematomas. 22 used anticoagulants. Managed with one

burr hole craniostomy. 218 had

drains and irrigation.


empyema), 6 (cardiovascular problems), 2 (post-operative

hemorrhage). Good recovery: 184.

Recurrence rate: 27. Second recurrence: 4.

Salahuddin67 (1996)


study




0 had drains.

Mortality: 0. Morbidity: 2 (cerebral edema), 1 (superficial wound

infection), 4 (seizure). Good

recovery: 18. Recurrence rate: 3, managed with burr hole. Second

recurrence: 0.

Ernestus et al68 (1997)


study



anticoagulants. 94 managed with

burr hole craniostomy and 10 with craniotomy. 104 had drains and

irrigation.

Mortality: burr hole: 2, craniotomy: 2. Good recovery: burr hole: 55,

craniotomy: 5. Recurrence rate: burr

hole: 17, craniotomy: 1.

Sambasivan69

(1997)

Retrospective

observational

study


Low


subdural hematomas. 51 managed

with multiple burr hole craniostomy, 9 with one burr hole,

2215 with craniotomy and

subtemporalis marsupialization, and 6 with craniotomy and

membranectomy. 2281 had drains

for 24 hours and irrigation.

Mortality: multiple burr: 2, one burr:

0, craniotomy subtemporalis

marsupialization: 11, craniotomy and membranectomy: 0. Morbidity:

multiple burr: 2 (infection). Good

recovery: multiple burr: 49, one burr: 9. craniotomy subtemporalis

marsupialization: 2204, craniotomy

and membranectomy: 6. Recurrence rate: multiple burr: 11, craniotomy

subtemporalis marsupialization: 8,

managed with multiple aspirations, burr hole, and membranectomies.

Smely et al70 (1997)


study



33 managed with percutaneous

twist drill drainage and 33 with one burr hole craniostomy. 66 had

drains and 33 had irrigation.

Mortality: percutaneous drainage: 2, burr hole: 3. Morbidity: percutaneous

drainage: 0, burr hole: 1 (cardiac

arrest), 1 (severe pain), 6 (wound infection or manifestation of

meningitis). Good recovery:

percutaneous drainage: 31, burr hole: 30. Recurrence rate: percutaneous

drainage: 6, burr hole: 11, managed

with percutaneous drainage and burr hole. Second recurrence:


2.

Tsutsumi et al71

(1997)

Randomized

trial




subdural hematomas. Managed with one burr hole craniostomy. 162 had

drains and 199 had irrigation.

Mortality: 0. Morbidity: 0.

Recurrence rate: with drainage: 3/177, without drainage: 9/53.

Yoshimoto et

al72 (1997)

Retrospective

observational

study


Low




0 had drains.



Zumkeller et

al73 (1997)

Retrospective

observational study


Low


hematomas. 21 used anticoagulants. Managed with burr hole

craniostomy.


(infection), 8 (secondary hemorrhage), 9 (pneumonia), 16

(seizure).

De Jesús et al74 Retrospective Newcastle-Ottawa Scale: 220 patients with 255 chronic Mortality: 2. Morbidity: 14

8


study

Low subdural hematomas. 115 managed

with one, 94 with two, and 22 with three burr hole craniostomy and 24

with craniotomy.

(postoperative seizure), 6

(intracerebral hematoma), 2 (tension pneumocephalus), 1 (acute subdural


Recurrence rate: one burr: 13, multiple burr: 7, Craniotomy: 0.


Kubota et al75 (1998)


study




Recurrence rate: 4.

Penchet et al76

(1998)

Retrospective

observational

study


Low


subdural hematomas. Managed with

burr hole craniostomy. 236 had drains.



Reinges et al77

(1998)

Prospective

observational study


High



Morbidity: 0.

Suzuki et al78 (1998)


study



hole craniostomy. 119 had drains

and 67 had irrigation.

Mortality: with irrigation: 1. Morbidity: with irrigation: 2 (acute

epidural hematoma). Recurrence rate:

with irrigation: 2, without irrigation: 4, managed with one burr hole.


Villagrasa et

al79 (1998)

Retrospective

observational

study


Low


hematomas. Managed with small

craniectomy.


Aung et al80

(1999)

Retrospective

observational

study


Low



hole craniostomy. 50 had drains for 48 hours, irrigation, and bed rest.


Beatty81 (1999)


study



craniotomy. 23 had irrigation and

drains.

Mortality: 2. Morbidity: 0. Good recovery: 21. Recurrence rate: 0.

Emonds et al82

(1999)

Prospective

observational

study


High



percutaneous twist drill drainage. 86 had drains and irrigation.

Mortality: 2. Morbidity: 2 (local skin

infection), 1 (multi-infarction

syndrome), 1 (pulmonary embolus). Good recovery: 79. Recurrence rate:

22, managed with percutaneous

drainage. Second recurrence: 6.

Hennig et al83

(1999)

Prospective

observational study


High


subdural hematomas. 128 managed with two burr hole craniostomy and

9 with craniotomy. 17 had drains

and 111 had irrigation (73 continuous for 48 hours and 38

peri-operative).

Mortality: burr hole: 5 (3 irrigation, 2

drainage), craniotomy: 1. Morbidity: burr hole: 3 (2 irrigation, 1 drainage).

Good recovery: 71/73. Recurrence

rate: burr hole: 22 (17 irrigation, 5 drainage), craniotomy: 4. Second

recurrence: 5.

Kaminogo et

al84 (1999)

Retrospective

observational

study


Low


hematomas. Managed with one burr

hole craniostomy. 38 had drains for 24 hours and irrigation.

Recurrence rate: 4.

Matsumoto et

al85 (1999)

Retrospective

observational study


Low


hematomas. 92 managed with one burr hole craniostomy and 29 with

two burr holes. 129 had closed



(pneumonia), 2 (myocardial infarction). Good recovery: 121.

Recurrence rate: 10. Second

recurrence: 1.

9

Gabarros et al86

(2000)

Retrospective

observational study


High


hematomas. 83 managed with two burr hole craniostomy and 105 by


188 had drains and 83 had irrigation.

Mortality: burr hole: 6, percutaneous

drainage: 3. Morbidity: burr hole: 14, percutaneous drainage: 7. Good

recovery: burr hole: 68, percutaneous

drainage: 100. Recurrence rate: burr hole: 10, percutaneous drainage: 15.

Hsu et al87

(2000)

Retrospective

observational study


Low



9 with craniotomy. 30 had drains,

96 had irrigation, and 100 had bed rest.


(nosocomial pneumonia), 1 (minor ischemic stroke), 2 (malpositioned

drain). Recurrence rate: 9 (two burr),

7 (two burr and external subdural drainage), 2 (craniotomy), 3

(craniotomy and external subdural

drainage), 9 managed with burr hole, 10 with craniotomy, 2 with shunts.

Kwon et al88 (2000)


study




adjuvant corticosteroids. 145 had drains, irrigation, and bed rest.

Recurrence rate: 6.

Missori et al89

(2000)

Retrospective

observational study


Low


hematomas. Managed with one burr hole craniostomy. 12 had drains for

24 hours and 31 had irrigation.


recovery: 29. Recurrence rate: 2, 1 managed surgically and 1 with low

dose corticosteroids. Second recurrence: 0.

Nakaguchi et

al90 (2000)

Prospective

observational study


High



craniostomy. 135 had drains for 48

hours and irrigation.


Ogasawara et

al91 (2000)

Retrospective

observational study


Low


hematomas. Managed with one burr hole craniostomy. 27 had drains for

24 hours.


0.

Reinges et al92 (2000)


study



Managed with percutaneous twist

drill drainage. 0 had drains and irrigation.

Mortality: 1. Morbidity: 5 (acute subdural bleeding), 1 (intracerebral

bleeding), 2 (acute subdural bleeding

with acute worsening of the neurological status), 7 (insufficient

hematoma evacuation and failure to

improve in neurological status), 3 (subdural empyema). Good recovery:

89. Recurrence rate: 11, managed

with craniotomy and bed rest. Second recurrence: 0.

Gelabert-González et al93

(2001)


study




system drainage.

Mortality: 7. Good recovery: 69. Recurrence rate: 6.

Gonugunta et

al94 (2001)

Retrospective

observational

study


Low



Managed with burr hole

craniostomy. 184 had drains and

irrigation.

Mortality: 1 (warfarin), 2 (no

warfarin). Good recovery: 27

(warfarin), 115 (no warfarin).

Recurrence rate: 5 (warfarin), 22 (no

warfarin), 19 managed with repeat burr hole for (no warfarin), 3 with

craniotomy for (no warfarin), 4 with

repeat burr hole for (warfarin), 1 with craniotomy for (warfarin).

Kuroki et al95

(2001)

Retrospective

observational


Low




recovery: 52 (without irrigation), 45

10

study hole craniostomy. 101 had drains


(with irrigation). Recurrence rate: 1

(without irrigation), 5 (with irrigation).

Leung et al96

(2001)

Retrospective

observational study


Low


hematomas. Managed with burr hole craniostomy. 46 had drains for

24 hours and 108 had irrigation.

Mortality: 4. Morbidity: 2 (seizure), 1

(intracranial infection). Recurrence rate: 6, 5 managed with burr hole and

1 with craniotomy. Second

recurrence: 0.

Mori et al97

(2001)

Retrospective

observational study


Low



craniostomy. 500 had drains and

irrigation.

Mortality: 6. Morbidity: 13 (acute

subdural hematoma), 4 (tension pneumocephalus), 2 (cerebral

infarction), 1 (putaminal

hemorrhage), 1 (acute epidural hematoma), 1 (subdural empyema), 1

(wound opening), 2 (pneumonia), 1

(ileus), 1 (disseminated intravascular coagulation).

Nakaguchi et

al98 (2001)

Retrospective

observational study


High


subdural hematomas. 0 used anticoagulants. 105 managed with


closed system drainage for 48 hours, irrigation, and bed rest.


Oishi et al99 (2001)


study




burr hole craniostomy. 116 had drains and irrigation.

Recurrence rate: 10 (8 with irrigation, 2 without irrigation), 9 managed with

reoperation, 1 conservatively.

Shono et al100 (2001)


study



hole craniostomy.

Recurrence rate: 0.

Tanikawa et al101 (2001)


study


49 patients with 48 chronic subdural hematomas. 33 managed with two

burr hole craniostomy and 16 with

craniotomy. 49 had drains and irrigation.

Mortality: burr hole: 1. Morbidity: burr hole: 1 (systemic infection and

multiple organ failure). Good

recovery: burr hole: 27, craniotomy: 16. Recurrence rate: burr hole: 4.

Williams et al102 (2001)


study


62 patients with chronic subdural hematomas. 51 managed with one


percutaneous twist drill drainage. 25 had drains and 51 had irrigation.

Mortality: 2. Good recovery: burr hole: 31 (no drainage), 13 (drainage),

percutaneous drainage: 4. Recurrence

rate: burr hole: 4 (no drainage), 1 (drainage), percutaneous drainage: 7.

Hirashima et

al103 (2002)

Prospective

observational study


High


hematomas. Managed with burr hole craniostomy. 0 had adjuvant

corticosteroids. 39 had irrigation.

Recurrence rate: 7, 5 managed

surgically and 2 conservatively. Second recurrence: 0.

Ishikawa et

al104 (2002)

Retrospective

observational

study


High



hole craniostomy. 26 had drains and irrigation.

Good recovery: 17.

Liliang et al105 (2002)


study




craniostomy. 75 had drains for 48 hours and irrigation.

Mortality: 1. Morbidity: 2 (meningitis), 1 (pneumonia). Good



Nakajima et

al106 (2002)

Randomized

trial

See results of the Cohcrane




craniostomy. 0 had drains, 46 had

Recurrence rate: 4 (bed rest), 3 (no

bed rest).

11

irrigation, and 25 had bed rest for

72 hours.

Okada et al107

(2002)

Retrospective

observational

study


Low



Managed with one burr hole craniostomy. 20 had drains,


Recurrence rate: 1 (drainage), 5

(irrigation). Second recurrence: 0.

Rohde et al108

(2002)

Retrospective

observational

study


High



hole craniostomy. 376 had drains, irrigation, and bed rest.


(seizure), 8 (intracerebral

hemorrhage), 8 (subdural empyema), 5 (epidural hematoma), 4

(pneumocephalus), 1 (intracerebral

abscess), 29 (pneumonia), 1 (pneumothorax), 9 (cardiac

arrhythmia), 1 (myocardial

infarction), 3 (decompensating heart insufficiency), 7

(thrombosis/pulmonary embolism), 6

(sepsis), 2 (gastric ulceration), 1 (renal failure). Good recovery: 259.


with craniotomy and 82 with burr hole.

Sato et al109 (2002)


study



one burr hole craniostomy. 195 had

drains for 24 hours.

Mortality: 1. Morbidity: 9. Recurrence rate: 18.

van Eck et al110

(2002)

Retrospective

observational

study


High



Managed with percutaneous twist drill drainage. 53 had drains and

irrigation.


recovery: 44. Recurrence rate: 8, 5

managed with burr hole and 3 with percutaneous drainage.

Asfora et al111

(2003)

Retrospective

observational

study


Low



percutaneous twist drill drainage. 32 had drains and bed rest. 0 had

irrigation.


6. Second recurrence: 0.

Imaizumi et al112 (2003)


study



36 managed with one burr hole

craniostomy and 23 conservatively. 36 had irrigation.


König et al113 (2003)


study



15 managed with burr hole

craniostomy and 6 with craniotomy. 15 had drains.

Good recovery: burr hole: 7, craniotomy: 3. Recurrence rate: burr

hole: 3, craniotomy: 2.

Kubo et al114 (2003)


study


34 patients with 35 chronic subdural hematomas. Managed with one burr

hole craniostomy. 34 had drains,


Good recovery: 34. Recurrence rate: 2, managed with one burr hole.

Lind et al115

(2003)

Retrospective

observational

study


High



anticoagulants. 188 managed with one burr hole craniostomy and 310

with two burr holes. 310 had drains



empyema) 1 with drainage and 4 with

no drainage. Recurrence rate: 31 (with drainage), 35 (no drainage).

Liu et al116

(2003)

Retrospective

observational


Low




Recurrence rate: 8.

12

study

hole craniostomy. 156 had drains.

Mohamed117 (2003)


study



Managed with frontal

temporoparietal craniotomy. 39 had drains, irrigation, and bed rest.

Mortality: 0. Morbidity: 5 (transient stage of agitation and delirium

suggesting hyperperfusion

syndrome), 3 (systemic chest infection), 3 (seizure). Good

recovery: 39. Recurrence rate: 5, 2

managed with percutaneous drainage and 3 with corticosteroids.

Mori et al118 (2003)


study


621 patients with chronic subdural hematomas. Managed with two burr


and irrigation.

Mortality: 9. Morbidity: 35 (acute subdural hematoma, tension

pneumocephalus, and systemic

complications such as pneumonia).

Tagle et al119

(2003)

Retrospective

observational

study


Low



hole craniostomy.

Mortality: 3. Good recovery: 81/87.


Yamamoto et

al120 (2003)

Retrospective

observational study


High



one burr hole craniostomy and 2

with two burr holes. 105 had drains and irrigation.


Zhang et al121 (2003)


study




and irrigation.

Recurrence rate: 15, managed with burr hole. Second recurrence: 1.

Baechli et al122

(2004)

Retrospective

observational

study


Low



anticoagulants. Managed with burr hole craniostomy. 354 had drains

for 48 hours.



Chen et al123

(2004)

Retrospective

observational

study


Low



burr hole craniostomy. 128 had closed system drainage.

Morbidity: 7 (seizure).

Frati et al124

(2004)

Prospective

observational study


High




hours, irrigation, and bed rest.

Morbidity: 2 (fever), 1 (infection of

skin incision). Recurrence rate: 5.

Gastone et al125

(2004)

Retrospective

observational study


High


subdural hematomas. 38 used anticoagulants. Managed with

enlarged one burr hole craniostomy.

0 had adjuvant corticosteroids. 159 had drains and irrigation.

Mortality: 5. Morbidity: 7 (dyspnoea

due to bronchopneumonia and airway secretion accumulation, partial motor

seizures, minor pulmonary embolism,

deep vein thrombosis, and urinary infection). Good recovery: 130.


recurrence: 0.

Iplikçioğlu et

al126 (2004)

Retrospective

observational study


Low


hematomas. Managed with burr hole craniostomy. 22 had drains.



Khan et al127

(2004)

Retrospective

observational study


Low



craniostomy.


(bronchopneumonia), 2 (seizure), 2 (wound infection). Good recovery:

40. Recurrence rate: 10.

Lee et al128

(2004)

Retrospective

observational


High




empyema). Good recovery: 82.

13

study 38 managed with two burr hole

craniostomy, 121 with enlarged craniectomy and partial

membranectomy, and 13 with

extended craniotomy and partial membranectomy. 172 had drains for

72 hours and irrigation.

Recurrence rate: two burr holes: 6,

enlarged craniectomy with partial membranectomy: 22, extended

craniotomy with partial

membranectomy: 3, 11 managed with extended craniotomy and

membranectomy, 20 with re-opening

of the burr holes or enlarged craniectomy. Second recurrence: 1.

Dakurah et al129

(2005)

Retrospective

observational study


High



one burr hole craniostomy and 15

with craniotomy. 81 had closed system drainage for 48 hours and

irrigation.


(pneumocephalus), 1 (intracerebral hemorrhage), 2 (cerebrospinal fluid

leakage), 1 (repeated seizure). Good

recovery: 90. Recurrence rate: craniotomy: 0, burr hole: 1, managed

with craniotomy. Second recurrence:

0.

Erol et al130

(2005)

Randomized

trial




subdural hematomas. Managed with burr hole craniostomy. 35 had

closed system drainage for 48 hours

and irrigation.

Mortality: 2 without drainage, 3 with

drainage. Morbidity: without drainage: 13 (pneumocephalus), 2

(pneumonia), 2 (urinary tract

infection), 1 (gastrointestinal bleeding), with drainage: 9

(pneumocephalus), 1 (tension

pneumocephalus), 1 (meningitis), 3 (urinary sepsis and pneumonia).

Good recovery: 29 without drainage,

27 with drainage. Recurrence rate: 6 without drainage, 5 with drainage,

managed with burr hole.

Gelabert-

González et

al131 (2005)

Retrospective

observational

study


High



anticoagulants. Managed with burr hole craniostomy. 1000 had closed

system drainage and irrigation.


(intracranial hypotension), 7

(subdural empyema), 4 (intracerebral hematoma), 2 (tension

pneumocephalus), 62 (post-operative

seizure), 22 (bronchopneumonia), 11

(cardiac problem), 8

(thromboembolic complication), 10

(septic complication). Good recovery: 979. Recurrence rate: 61. Second

recurrence: 6.

Gurunathan132 (2005)


study



hole craniostomy. 0 had drains and

103 had irrigation.

Mortality: 1. Recurrence rate: 5, managed with one burr hole. Second

recurrence: 2.

Jeong et al133

(2005)

Retrospective

observational study


Low


hematomas. Managed with burr hole craniostomy. 138 had drainage

and irrigation.

Recurrence: 8, managed with burr

holes. Second recurrence: 0.

Kim et al134

(2005)

Retrospective

observational

study


Low



hole craniostomy. 71 had drainage.


Recurrence: 3, managed with burr

holes. Second recurrence: 2.

Lee et al135

(2005)

Retrospective

observational

study


Low



percutaneous twist drill drainage. 31had drainage.


hematoma). Cure rate: 25. Recurrence

rate: 1, managed with percutaneous drainage. Second recurrence: 0.

Miele et al136 (2005)


study




had closed system drainage. 0 had irrigation.

Morbidity: 13, including 6 (pneumocephalus), 2 (acute subdural


Recurrence rate: 16, 2 managed with percutaneous drainage and 14 with

14

burr hole or craniotomy. Second

recurrence: 4.

Muzii et al137

(2005)

Randomized

trial





22 managed with percutaneous twist drill drainage and 24 with burr




burr hole: 2. Morbidity: 0 for both.

Good recovery: percutaneous drainage: 20, burr hole: 17.

Recurrence rate: percutaneous

drainage: 1, burr hole: 5, managed with burr hole. Second recurrence: 0

for both.

Stanisic et al138

(2005)

Retrospective

observational

study


High



anticoagulants. 119 managed with one burr hole craniostomy and 2

with two burr holes. 82 had closed

system drainage for 24-48 hours and bed rest. 121 had irrigation.

Mortality: 7. Morbidity: 1 (superficial

wound infection), 3 (subdural

empyema). Good recovery: 100. Recurrence rate: 18, 13 managed with

repeated evacuation and flushing

through the previous burr hole, 3 with second burr hole, and 2 with

craniotomy. Second recurrence: 2.

Sun et al139 (2005)


study



26 managed with dexamethasone,

82 with burr hole craniostomy, and 4 conservatively. 69/82 had

adjuvant corticosteroids. 0 had drains and bed rest. 82 had

irrigation.

Mortality: dexamethasone group: 1, burr hole: 2 with adjuvant

dexamethasone, 2 without

dexamethasone, conservative: 2. Morbidity: dexamethasone group: 1

(subarachnoid hemorrhage), burr hole: with dexamethasone: 1 (urinary

tract and chest infection), 1

(intracerebral hemorrhage), without dexamethasone: 1 (chest infection), 1

(carcinoma of rectum), conservative:

1 (liver failure), 1 (deterioration in general condition). Good recovery:

dexamethasone group: 23, burr hole:

63 with adjuvant dexamethasone, 10 without dexamethasone,

conservative: 2. Recurrence rate:

dexamethasone group: 1, burr hole: 3

with adjuvant dexamethasone, 2

without dexamethasone,

conservative: 2, managed with burr hole.

Bozkurt et al140

(2006)

Prospective

observational study


High



had drains and 20 had irrigation.


Recurrence rate: 7, managed with percutaneous drainage. Second

recurrence: 2.

Horn et al141

(2006)

Prospective

observational

study


High



percutaneous twist drill drainage and 24 with burr hole craniostomy.

79 had drains and 55 had irrigation.


burr hole: 3. Morbidity: percutaneous

drainage: 3 (acute subdural hematoma), 2 (respiratory failure), 1

(myocardial failure), 1 (seizure), 1

(sepsis), burr hole: 1 (reoperation for wound revision), 1 (acute subdural

hematoma), 1 (stroke). Good

recovery: percutaneous drainage: 46, burr hole: 18. Recurrence rate:


3.

Takeda et al142

(2006)

Retrospective

observational study


Low


hematomas. 15 used anticoagulants. Managed with percutaneous twist

drill drainage. 0 had drains,


Morbidity: 1 (acute subdural

hematoma). Good recovery: 70. Recurrence rate: 7, managed with

percutaneous drainage. Second

recurrence: 3.

Wada et al143 Retrospective Newcastle-Ottawa Scale: 34 patients with chronic subdural Recurrence rate: 1.

15


study


Managed with one burr hole craniostomy. 34 had closed system


Xie et al144 (2006)


study


84 patients with chronic subdural hematomas. 69 patients managed

with burr holes and 15 with

craniotomy.

Mortality: burr: 0, craniotomy: 1. Cure rate: burr: 65, craniotomy: 14.

Recurrence: burr: 4, craniotomy: 0.


Abouzari et

al145 (2007)

Randomized

trial






hours and irrigation. 42 had bed rest for 72 hours.

Morbidity: bed rest: 10 (atelectasis), 5

(pneumonia), 3 (decubitus ulcer), no bed rest: 7 (atelectasis), 4

(pneumonia), 2 (decubitus ulcer), 1

(deep vein thrombosis). Recurrence rate: 1 (bed rest), 8 (no bed rest).

Amirjamshidi

et al146 (2007)

Prospective

observational study


High




drainage for 24-48 hours and irrigation.


Recurrence rate: 10, managed with one burr hole.

Amirjamshidi et al147 (2007)


study



Managed with one burr hole

craniostomy. 116 had closed system drainage for 24-48 hours and

irrigation.

Good recovery: 92.

Gazzeri et al148

(2007)

Retrospective

observational

study


High



anticoagulants. Managed with one burr hole craniostomy. 224 had

drainage with a Jackson pratt drain

in the subgaleal space with the suction facing the burr hole for 48-

72 hours. 224 had irrigation and bed

rest.

Mortality: 2. Morbidity: 1 (subgaleal

empyema), 2 (partial motor seizure),

2 (pneumonia), 1 (acute subdural hematoma/multi-organ failure).


one burr hole. Second recurrence: 0.

Gurelik et al149

(2007)

Randomized

trial





hole craniostomy and 38 with percutaneous twist drill drainage. 80

had closed system drainage for 48


Recurrence rate: burr hole: 8,

percutaneous drainage: 4.

Kang et al150

(2007)

Retrospective

observational study


Low



closed-system drainage for 48 hours

with a silicon catheter and bag.


one burr hole.

Kiymaz et al151

(2007)

Retrospective

observational study


Low



craniostomy. 29 had drains. 50 had

irrigation and bed rest.

Recurrence rate: 8 (2 with drainage, 6

without drainage).

Maarrawi et

al152 (2007)

Retrospective

observational

study


High



with burr hole craniostomy and 45 with percutaneous twist drill

drainage. 0 had adjuvant

corticosteroids. 154 had closed system drainage for 24 hours and

109 had irrigation.

Mortality: burr hole: 1, percutaneous

drainage: 0. Morbidity: burr hole: 1

(meningitis), 4 (severe pneumocephalus), 6 (seizure), 2

(intracerebral hematoma), 2

(hygroma), percutaneous drainage: 1 (seizure). Good recovery: burr hole:

107, percutaneous drainage: 45.


16

percutaneous drainage: 1, 13

managed with trephination, 2 with craniotomy, and 1 with percutaneous

drainage.

Santos-Ditto et al153 (2007)


study




Morbidity: 19. Good recovery: 208. Recurrence rate: 17, managed with

percutaneous drainage. Second

recurrence: 0.

Sucu et al154

(2007)

Retrospective

observational study


High



had drains.

Morbidity: 1 (brain penetration), 1

(inability to penetrate the dura mater with the drill), 1 (epidural

hematoma), 3 (catheter folding).

Recurrence rate: 1, managed with burr hole.

Tokmak et al155

(2007)

Retrospective

observational study


High



craniostomy. 24 had drains for 72-

96 hours.


burr hole.

Weigel et al156

(2007)

Prospective

observational study


High


hematomas. Managed with burr hole craniostomy. 310 had closed



Gökmen et al157

(2008)

Randomized

trial





percutaneous twist drill drainage and 32 with one burr hole

craniostomy. 70 had drainage for 48

hours and 32 had irrigation.


burr hole: 1. Morbidity: burr hole: 0,

percutaneous drainage: 1 (temporary sixth nerve paresis), 1 (epidural

hematoma), 1 (inability to perforate

the dura), 2 (kinking of the drain). Good recovery: burr hole: 26,

percutaneous drainage: 29.

Recurrence rate: burr hole: 2, percutaneous drainage: 1.

Guzel et al158

(2008)

Prospective

observational study


High


hematomas. Managed with one burr hole craniostomy. 20 had closed

system drainage for 42-72 hours

and irrigation.



Khadka et al159

(2008)

Retrospective

observational study


Low


hematomas. Managed with one burr hole craniostomy. 117 had adjuvant

corticosteroids. 0 had drains. 365

had bed rest for 48 hours and irrigation.

Mortality: 5. Morbidity: 4 (superficial

wound infection), 1 (subdural empyema), 1 (intracerebral


Recurrence rate: 17, managed with one burr hole. Second recurrence: 0.

Ko et al160 (2008)


study




burr hole craniostomy. 255 had closed system drainage for 48 hours

and bed rest. 0 had irrigation.

Recurrence rate: 24, managed with one burr hole. Second recurrence: 3

Kristof et al161 (2008)


study






Park et al162

(2008)

Retrospective

observational study


High



craniostomy. 24 had irrigation.


(myocardial infarction). Good recovery: 23. Recurrence rate: 3.

17

Ramnarayan et

al163 (2008)

Retrospective

observational study


Low



drill drainage. 42 had closed system

drainage. 0 had bed rest.


(myocardial infarction), 1 (pneumonia), 1 (seizure). Good

recovery: 37.

Schebesch et

al164 (2008)

Retrospective

observational

study


Low



with burr hole craniostomy.


Secer et al165

(2008)

Retrospective

observational study


Low


hematomas. Managed with two burr hole craniostomy. 45 had drainage

and irrigation.

Mortality: 6. Morbidity: 0. Cure rate:

33. Recurrence: 8, 6 managed with craniotomy and 2 with burr holes.


Taussky et al166 (2008)


study




craniostomy and 63 with two burr holes. 97 had closed system

drainage for 48 hours, bed rest, and

irrigation.

Mortality: 1 (one burr hole). Morbidity: 3 (wound infection), 3 for

one burr, 0 for two burr holes.

Recurrence rate: 13 (10 one burr hole, 3 two burr holes), 8 managed with

burr hole, 5 with subduroperitoneal

shunt. Second recurrence: 5.

Torihashi et

al167 (2008)

Retrospective

observational study


High




irrigation.



Zakaraia et al168

(2008)

Randomized

trial




hematomas. 0 used anticoagulants. 40 managed with two burr hole

craniostomy and 42 with one burr

hole. 82 had closed system drainage for 72 hours. 40 had irrigation.


recovery: 35 (two burr holes), 35 (one burr hole). Recurrence rate: 4 (two

burr holes), 6 (one burr hole), 4

managed with two burr holes and 6 with one burr hole.

Abouzari et

al169 (2009)

Retrospective

observational study


Low



craniostomy.

Good recovery: 228.

Akhaddar et

al170 (2009)

Retrospective

observational

study


Low



anticoagulants. Managed with burr hole craniostomy. 110 had drains.


(intraparenchymal hematoma), 1

(epidural hematoma), 2 (subdural empyema and severe pneumonia).


8. Second recurrence: 1.

Delgado-López

et al171 (2009)

Retrospective

observational

study


High



anticoagulants. 15 managed with percutaneous twist drill drainage, 4

with craniotomy, 101 with dexamethasone, and 2

conservatively. 0 had adjuvant

corticosteroids. 15 had closed system drainage for 48-72 hours. 0

had irrigation. 101 had bed rest.


craniotomy: 0, dexamethasone: 1,

conservative: 0. Good recovery: percutaneous drainage: 14,

craniotomy: 3, dexamethasone: 97, conservative: 2. Recurrence rate:

percutaneous drainage: 2,

dexamethasone: 22, conservative: 0, managed with percutaneous drainage.

Second recurrence: percutaneous

drainage: 0, dexamethasone: 3,

conservative: 0.

Grobelny et

al172 (2009)

Retrospective

observational study


High


hematomas. Managed with burr hole craniostomy.


Han et al173 (2009)


study



51 one burr hole craniostomy and

129 two burr holes. 180 had closed

Recurrence rate: 1 (one burr hole), 9 (two burr holes), 1 managed with one

burr hole and 9 with two burr holes.

18

system drainage for 120 hours,


Hong et al174

(2009)

Prospective

observational

study


High



Managed with burr hole craniostomy. 66 had drains for 72


Recurrence: 14, managed by 10 one

burr hole, 3 additional burr hole, 1

craniotomy.

Hwang et al175

(2009)

Prospective

observational

study


High



percutaneous twist drill drainage. 30 had closed system drainage and bed

rest for 24 hours.



managed with percutaneous drainage. Second recurrence: 0.

Ishfaq et al176 (2009)


study


60 patients with 69 chronic subdural hematomas. Managed with 47 one


two burr holes. 60 had closed system drainage and bed rest.

Morbidity: 7 (weakness of the contralateral limbs), 3 (wound

infection), 5 (seizure). Good

recovery: 51. Recurrence rate: 7, managed with repeated burr hole.


Lee et al177

(2009)

Retrospective

observational

study


High


hematomas. Managed with 25 one

burr hole craniostomy, 32 with two burr holes, and 30 with small

craniotomy. 87 had closed system

drainage and 75 had irrigation.

Morbidity: one burr hole: 4

complications such as (wound

infection, decreased mentality, hemothorax, pneumonia), two burr

holes: 4 (partial seizure attack,

general tonic clonic seizure attack, pneumonia, hematochezia, left side

motor weakness), craniotomy: 1

(pneumonia). Recurrence rate: one burr hole: 6, two burr holes: 7,

craniotomy: 2.

Lindvall et al178

(2009)

Retrospective

observational

study


High



59 managed with burr hole craniostomy, 7 with craniotomy,

and 5 conservatively. 66 had closed

system drainage with a subdural catheter connected to a plastic bag

with the bag placed at bed level for

24-48 hours. 59 had irrigation.


(neurological deficits, decreased level

of consciousness, or severe headache), 1 (subdural empyema).


burr hole: 10, craniotomy: 1, conservative: 0, 8 managed with burr

hole and 3 with craniotomy. Second

recurrence: 0.

Mondorf et

al179 (2009)

Retrospective

observational

study


Low



anticoagulants. 151 managed with craniotomy and 42 with burr hole

craniostomy. 190 had low vacuum

suction reservoir drainage for maximum 72 hours. 193 had

irrigation.

Mortality: craniotomy: 7, burr hole:

1. Morbidity: 14 (postoperative

seizure). Good recovery: craniotomy: 104, burr hole: 36. Recurrence rate:

craniotomy: 42, burr hole: 6.

Radisavljevic

et al180 (2009)

Retrospective

observational

study


Low



hole craniostomy. 93 had drainage for 48 hours, irrigation, and bed

rest.

Recurrence rate: 6, managed with one


Santarius et

al181 (2009)

Randomized

trial




hematomas. 21 used anticoagulants

(with drain), 28 antiplatelets (with drain), 18 anticoagulants (without

drain), and 36 antiplatelets (without

drain). 215 managed with two burr hole craniostomy. 108 had drains

for 48 hours. 215 had irrigation.

Mortality: 4 (with drainage), 8

(without drainage). Morbidity: 3

subdural empyemas (1 with drainage, 2 without drainage), 1 intracerebral

hematoma (without drainage), 1 acute

subdural hematoma (without drainage), 5 pneumonias (3 with

drainage, 2 without drainage), 2 renal

failures (1 each), 2 urinary tract infections (1 each), 1 myocardial

19

infarction (with drainage), 1 atrial

fibrillation (without drainage), 1 gastritis (without drainage). Good

recovery: 81 out of 97 (with

drainage), 64 out of 95 (without drainage). Recurrence rate: 10 (with

drainage), 26 (without drainage).

Shimamura et al182 (2009)

Randomized trial

See results of the Cochrane risk of bias assessment tool


Managed with one burr hole

craniostomy. 79 had closed system drainage for 24 hours and irrigation.


Yu et al183 (2009)


study




closed system drainage, irrigation, and bed rest.

Mortality: 2. Morbidity: 1 (minor skin incision infection). Recurrence rate:

8.

Zumofen et

al184 (2009)

Retrospective

observational study


High


subdural hematomas. 37 used antiplatelets. Managed with two


subperiostal/extracranial passive draining system for 48 hours. 147

had irrigation and bed rest.


bleeding), 1 (epidural bleeding), 1 (cardiac arrest), 1 (severe

atelectasis/cardiopulmonary failure),

2 (superficial wound infection), 1 (deep wound infection/subdural

empyema), 12 (postoperative seizure). Good recovery: 108.

Recurrence rate: 22, 15 managed with

second trephination, 2 with craniotomy, and 5 conservatively.

Ibrahim et al185

(2010)

Randomized

trial




hematomas. 26 used anticoagulants (15 in 48 hours group, 11 in 96

hours group). Managed with

percutaneous twist drill drainage. 65 had drains and bed rest (35 in 48

hour group, 30 in 96 hours group).

Mortality: 5 (1 in 48 hours drainage,

4 in 96 hours drainage). Morbidity: 3 (2 from neurologic and 1 from

general complication [urinary

infection] in 48 hours), 9 (2 from neurologic and 7 from general

complications [1 urinary infection, 3

respiratory infections, 1 dehydration, 1 insufficient poly-visceral, 1 inferior

membrane infection] in 96 hours).

Good recovery: 30 (48 hours drainage), 25 (96 hours drainage).

Recurrence rate: 4 (48 hours

drainage), 3 (96 hours drainage).

Kanat et al186

(2010)

Retrospective

observational study


Low


hematomas. Managed with burr hole craniostomy.


Kansal et al187 (2010)


study




craniostomy and 72 with two burr holes. 0 had adjuvant

corticosteroids and drains. 267 had

irrigation and bed rest.

Recurrence rate: 26 (one burr hole), 6 (two burr holes), 26 managed with

one burr hole and 6 with two burr

holes.

Kenning et al188

(2010)

Retrospective

observational

study


High



Managed with percutaneous twist drainage. 74 had subdural

evacuating port drainage system.

Morbidity: 2 (acute postoperative

hemorrhage). Recurrence rate: 22, 1

managed with burr hole and 21 with craniotomy. Second recurrence: 1.

Kurabe et al189

(2010)

Retrospective

observational

study


High



anticoagulants (15 with bed rest, 23 without bed rest). Managed with

Morbidity: with bed rest: 1

(arrhythmia), 4 (pneumonia), 2

(ileus), 2 (pseudomembranous colitis), 4 (constipation), 6 (urinary

20


closed system drainage for 48 hours (with bed rest) and same day as

operation (without bed rest).

tract infection), 2 (seizure), 3

(eruption), without bed rest: 1 (arrhythmia), 1 (pneumonia), 2

(constipation), 1 (urinary tract

infection), 1 (cerebral infarction), 2 (seizure). Recurrence rate: 14 (6 with

bed rest, 8 without bed rest). Second

recurrence: 1.

Liu et al190

(2010)

Retrospective

observational

study


Low



anticoagulants. Managed with burr hole craniostomy. 398 had drains

and irrigation.


abscess), 3 (pneumonia). Good


Mino et al191

(2010)

Retrospective

observational

study


Low



hole craniostomy.

Recurrence rate: 4

Nagashima et

al192 (2010)

Retrospective

observational

study


Low



hole craniostomy.172 had closed system drainage.


Oh et al193 (2010)


study



burr hole craniostomy, 3 with two

burr holes, and 3 with craniotomy. 149 had drainage for 48 hours.

Good recovery: 131. Recurrence rate: craniotomy: 0, burr hole: 18, 11

managed with one burr hole and

bilateral burr holes. 7 were managed conservatively and their chronic

subdural hematoma resolved

spontaneously. Second recurrence: 4.

Rehman et al194

(2010)

Retrospective

observational study


Low



craniostomy. 0 had drains and 60

had irrigation.


(pneumocephalus), 2 (intracerebral hemorrhage), 4 (chest infection), 4

(seizure). Good recovery: 52.

Recurrence rate: 4.

Rughani et al195

(2010)

Retrospective

observational

study


High



21 managed with percutaneous twist drill drainage and 21 with burr

hole craniostomy. 21 had subdural

evacuating port drainage system and 21 had ventriculostomy catheter

drainage. 21 had irrigation.



drainage: 0 (infection), 1 (acute hemorrhage), 1 (seizure), burr hole: 0

(infection), 0 (acute hemorrhage), 1

(seizure). Recurrence rate: percutaneous drainage: 5, burr hole:

3.

Santarius et

al196 (2010)


study


High



hole craniostomy. 408 had drains for 48 hours and irrigation.


craniotomy and 63 with burr hole.


Senturk et al197 (2010)


study


34 patients with 48 chronic subdural hematomas. Managed with burr


Mortality: 1. Morbidity: 1 (adult respiratory distress syndrome). Good


Tsai et al198 (2010)


study



anticoagulants. Managed with burr

hole craniostomy. 129 had closed system drainage with no suction and

irrigation.

Mortality: 11. Morbidity: 0 (tension pneumocephalus), 25 (seizure), 4

(infection), 3 (hydrocephalus), 2

(acute subdural hematoma). Good recovery: 117. Recurrence rate: 12.

White et al199

(2010)

Retrospective

observational

study


High



130 managed with burr hole craniostomy and 116 with

minicraniotomy. 4 had drains.

Mortality: burr hole: 10, craniotomy:

20. Morbidity: burr hole: 2 (subdural

empyema), 12 (seizure), craniotomy: 3 (subdural empyema), 10 (seizure).

Good recovery: burr hole: 64 out of

77, craniotomy: 66 out of 90.

21


craniotomy: 23.

Bankole et al200

(2011)

Prospective

observational

study


High



70 managed with one burr hole craniostomy and 3 with craniotomy.

73 had closed system drainage for


Mortality: 3/48. Morbidity: 2/48

(seizure), 1/48 (intracerebral

hematoma), 1/48 (pneumocephalus), 1/48 (urinary retention). Good

recovery: 44/48. Recurrence rate:

6/48.

Carlsen et al201

(2011)

Retrospective

observational study


Low


hematomas. Managed with one burr hole craniostomy. 206 had drainage

from the subgaleal space or

subdural space for 24 hours and irrigation.

Mortality: 2 (1 with drainage, 1

without drainage). Morbidity: 5 (acute subdural hematoma) 2 with

drainage, 3 without drainage.

Recurrence rate: 65 (29 with drainage), (36 without drainage).

Escosa Baé et

al202 (2011)

Retrospective

observational study


High



312 had adjuvant corticosteroids. 0

had irrigation. 312 had drains for 8-48 hours and bed rest.

Mortality: 3. Morbidity: 22 (local

hematoma), 3 (acute subdural hematoma), 5 (brain damage). Good


Hazra et al203 (2011)


study



hole craniostomy and middle

meningeal artery embolization for refractory hematomas. 188 had

irrigation.

Recurrence rate: 13, managed with burr hole. Second recurrence: 2.

Huang et al204

(2011)

Retrospective

observational

study


High



hole craniostomy. 100 had closed system drainage and irrigation.


(pneumonia), 3 (urinary tract

infection), 11 (seizure). Good recovery: 95. Recurrence rate: 39,

managed with craniotomy.

Ishibashi et al205 (2011)


study




burr hole craniostomy. 92 had closed system drainage with a

collection bag for 24-48 hours. 34

had irrigation and 92 had bed rest.

Mortality: 2 (drainage), 0 (drainage with irrigation). Good recovery: 48

(drainage), 34 (drainage with

irrigation). Recurrence rate: 6 (drainage), 1 (drainage with

irrigation).

Javadi et al206

(2011)

Randomized

trial




hematomas. 9 used antiplatelets. Managed with two burr hole


bag drainage adjusted at the level of patient's head without negative

pressure for 48 hours and 40 had

irrigation.

Mortality: 4 (with drainage), 2

(without drainage). Morbidity: 4 with drainage: 2 (deep vein thrombosis), 1

(acute subdural hematoma), 1 (renal

failure), 2 without drainage: 1 (aspiration pneumonia), 1 (tension

pneumocephalus and status

epilepticus). Good recovery: 12 (with drainage), 10 (without drainage).

Recurrence rate: 1 (with drainage), 1

(without drainage), managed with two burr holes.

Kaiser et al207

(2011)

Retrospective

observational

study


Low




irrigation.


Kim et al208

(2011)

Retrospective

observational

study


High



hole craniostomy, 16 with small craniotomy (3-4 cm diameter) and

partial membranectomy, and 42

with large craniotomy (diameter of

Mortality: burr hole: 21, small

craniotomy: 0, extended craniotomy:

2. Morbidity: burr hole: 9 (local postoperative complications such as

surgical wound infection, tension

pneumocephalus, epidural hematoma,

22

hematoma) and extended

membranectomy. 259 had closed system drainage for 48-72 hours.

and seizure), 29 (systemic

complications such as pneumonia and sepsis), small craniotomy: 1 (local

postoperative complication), 1

(systemic complication), extended craniotomy: 2 (local postoperative

complication), 2 (systemic

complication). Good recovery: burr hole: 202, small craniotomy: 7,

extended craniotomy: 17. Recurrence

rate: burr hole: 23, small craniotomy: 8, extended craniotomy: 4, 25

managed with repeated burr hole and

10 with large craniotomy.

Lin209

(2011)

Retrospective

observational

study


High



with percutaneous twist drill drainage and 270 with one burr hole


drainage for average of 72 hours and 270 had irrigation.



drainage: 0, burr hole: 4 (infection), 6 (tension pneumocephalus), 5 (brain

injury), 9 (seizure). Good recovery:

percutaneous drainage: 158, burr hole: 204. Recurrence rate:


32, 36 managed with percutaneous drainage and 10 with one burr hole.

Mezue et al210 (2011)


study


246 patients with chronic subdural hematomas. 19 used antiplatelets.


craniostomy. 246 had drains.


burr hole.

Miranda et al211

(2011)

Retrospective

observational study


High


subdural hematomas. 81 used antiplatelets. 21 managed with two

burr hole craniostomy, 44 with

percutaneous twist drill drainage, 72 with craniotomy, and 72

conservatively. 137 had closed

system drainage for 24-72 hours



Recurrence rate: two burr holes: 1, percutaneous drainage: 4,

craniotomy: 0, conservative: 0,

managed with craniotomy.

Mostofi et al212

(2011)

Retrospective

observational study


Low



drill drainage. 0 had adjuvant

corticosteroids. 28 had bed rest.



Park et al213

(2011)

Prospective observational study


High



craniostomy. 31 had adjuvant

dexamethasone, drainage, and irrigation.


1.

Sarnvivad et al214 (2011)


study




craniostomy. 97 had drainage and 143 had irrigation.

Mortality: 2 (drainage), 1 (without drainage). Morbidity: 2 (drainage), 1

(without drainage). Good recovery:

79 (drainage), 32 (without drainage). Recurrence rate: 15 (drainage), 12

(without drainage).

Singh et al215 (2011)

Randomized trial

See results of the Cochrane risk of bias assessment tool

100 patients with chronic subdural hematomas. 48 managed with

percutaneous twist drill drainage

and 52 with two burr holes craniostomy. 100 had drainage and

irrigation.

Mortality: percutaneous: 2, burr: 0. Morbidity: percutaneous: 1 (wound

infection), 5 (hematoma formation), 1

(meningitis), burr: 3 (wound infections), 4 (subdural hemorrhage

or parenchymal contusion) in 49

patients. Cure rate: percutaneous: 42, burr: 49. Recurrence: percutaneous:

23

4, burr: 1.

Adeolu et al216 (2012)


study


50 patients with 62 chronic subdural hematomas. Managed with burr

hole craniostomy. 50 had bed rest.

Morbidity: 1 (infection), 1 (pnemocephalus). Good recovery: 45.

Recurrence rate: 0.

Bellut et al217

(2012)

Retrospective

observational

study


High


subdural hematomas. 11 used oral

anticoagulation (subperiosteal drainage), 17 antiplatelets

(subperiosteal), 18 oral

anticoagulation (subdural), and 16 antiplatelets (subdural). 113

managed with two burr hole

craniostomy. 48 had subperiosteal drainage and 65 had subdural for 48

hours. 113 had irrigation and bed

rest.

Mortality: 1 (subdural). Morbidity:

overall 25 periosteal & 39 subdural,

subperiosteal: 3 (clinical remnant), 12 (urinary tract infection), 3

(pneumonia), 6 (others), 5 (paresis), 2

(aphasia), 6 (headaches), 21 (physical imbalance), 1 (seizure), 9 (acute

states of confusion), subdural: 1

(clinical remnant), 4 (intracerebral hematoma), 14 (urinary tract

infection), 9 (pneumonia), 9 (others),

9 (paresis), 7 (aphasia), 15 (headache), 16 (physical imbalance),

4 (seizure), 10 (acute states of

confusion). Good recovery: 18 (subperiosteal), 26 (subdural).

Recurrence rate: 1 (subperiosteal), 2

(subdural).

Berghauser

Pont et al218 (2012)

Retrospective

observational study


High



two burr hole craniostomy and 114

with one burr hole. 496 had adjuvant corticosteroids and

irrigation. 440 had closed system

drainage for maximum 48 hours and bed rest.

Mortality: 26. Morbidity: 52 (urinary

tract and/or pulmonary infection), 9 (deep venous/pulmonary embolism),

14 (subdural empyema), 4 (post-

operative wound infection). Recurrence rate: 59.

Borger et al219

(2012)

Retrospective observational study


High




closed system drainage and irrigation.


(intracerebral hemorrhage), 9 (acute subdural hematoma), 5 (epidural

hematoma), 3 (cerebral infarction), 2

(infection). Good recovery: 289. Recurrence rate: 89.

Chon et al220 (2012)


study



anticoagulants and 117 used

antiplatelets. Managed with one burr hole craniostomy. 0 had

adjuvant corticosteroids. 420 had closed system drainage maintained 50 cm below head level for 72


Morbidity: 1 (epidural hematoma), 1 (intracerebral hemorrhage), 8

(infection). Recurrence rate: 92.


de Araujo Silva

et al221 (2012)

Retrospective

observational

study


Low



burr hole craniostomy. 117 had drainage and 125 had irrigation.

Mortality: 14. Morbidity: 3 (wound

infections). Cure rate: 103. recurrence

rate: 11.

Ducruet et al222

(2012)

Retrospective

observational

study


Low



hole craniostomy.


Janowski et al223 (2012)


study


45 patients with 48 chronic subdural hematomas. Managed with two burr

hole craniostomy. 44 had drains for

24 hours.

Mortality: 0. Morbidity: 0. Good recovery: 42. Recurrence rate: 7,

managed with two burr holes. Second

recurrence: 0.

Kaliaperumal

et al224 (2012)

Randomized

trial






Mortality: 1. Morbidity: 2 (1 seizure

and 1 intraparenchymal placement of

a drain). Recurrence rate: 0.

24

craniostomy. 50 had drains (25

subdural and 25 periosteal) and irrigation.

Khan225

(2012)

Retrospective

observational study


Low


hematomas. Managed with two burr hole craniostomy. 47 had subdural

drainage.


Kitazono et

al226 (2012)

Retrospective

observational

study


Low




Recurrence: 2.

Kong et al227

(2012)

Retrospective

observational

study


High



with one burr hole craniostomy and 104 with two burr hole

craniostomy. 136 had drainage and

irrigation.



Krieg et al228

(2012)

Retrospective

observational study


High


hematomas. 183 used anticoagulants. Managed with

hallow screw placement. 320 had

closed system drainage and irrigation.


hematoma), 5 (meningitis), 53 (bladder infection), 26 (seizure), 15

(pneumonia), 5 (stroke), 3

(pulmonary embolism), 2 (thrombosis). Good recovery: 257.


with hollow screw placement, 65 with burr hole, and 1 with craniotomy.

Latini et al229 (2012)


study




trans-marrow puncture. 116 had closed system drainage.

Mortality: 6. Morbidity: 2 (respiratory infection), 1 (heart

disease), 1 (coagulopathy), 1

(intracranial hemorrhage), 1 (general deterioration/sepsis). Recurrence rate:

50, managed with trans-marrow

puncture. Second recurrence: 10.

Lee et al230

(2012)

Retrospective

observational

study


High



percutaneous twist drill drainage. 134 had drainage and 0 had

irrigation.

Morbidity: 2. Cure rate: 114.


burr holes and 1 with percutaneous drainage.

Nayil et al231

(2012)

Retrospective

observational

study


High



anticoagulants. Managed with two burr hole craniostomy. 1305/1347

procedures had subdural space

drainage for 48 hours. 1181 had irrigation and bed rest.


subdural hematoma), 1 (acute

epidural hematoma), 1 (large thalamic hematoma), 8 (seizure), 9 (empyema).

Good recovery: 733/1013.

Recurrence rate: 43 (ipsilateral), 14 (opposite side), 43 managed with

reopening of the pervious burr hole

and 14 with two burr holes. Second recurrence: 9.

Neal et al232 (2012)


study





159 had hermatically sealed

drainage for 24 hours and 0 had

irrigation.

Good recovery: 129. Recurrence rate: 30.

Neils et al233

(2012)

Retrospective

observational

study


High



burr hole craniostomy, 3 with two burr holes and tissue plasminogen

activator, 73 with percutaneous

twist drill drainage, and 12 with


6 (two burr), 0 (two burr and tissue

plasminogen activator), 22 (percutaneous drainage), 0

(percutaneous drainage and tissue

plasminogen activator).

25

percutaneous twist drill drainage

and tissue plasminogen activator. 139 had drainage and 54 had

irrigation.

Secer et al234 (2012)


study



hole craaniostomy. 0 had drains and

32 had irrigation.


Stanisic et al235

(2012)

Prospective

observational study


High


hematomas. 18 used antiplatelets and 7 used anticoagulants. Managed

with one burr hole craniostomy for



Recurrence rate: 3, managed with one burr hole.

Sundstrøm et

al236 (2012)

Prospective

observational

study


High



hole craniostomy.


Tahsim-Oglou

et al237 (2012)

Prospective

observational study


High


subdural hematomas. Managed with two burr hole craniostomy. 247 had

drains for 48 hours and irrigation.


revision of surgery. Second recurrence: 13.

Takayama et al238 (2012)


study



hole craniostomy. 239 had irrigation and drainage.


Wakabayashi et

al239 (2012)

Prospective

observational study


High


hematomas. Managed with one burr hole craniostomy. 199 had drainage.


Yeon et al240 (2012)


study




craniostomy. 20 had drains for 24-48 hours. 0 had bed rest.

Mortality: 1. Morbidity: 1 (fever/infection), 1 (pulmonary

edema). Good recovery: 16.

Recurrence rate: 3, managed with burr hole. Second recurrence: 0

Baraniskin et

al241 (2013)

Retrospective

observational study


High



had drainage and irrigation.


Bosche et al242

(2012)

Prospective

observational

study


High



Managed with burr hole craniostomy. 18 had closed system

drainage for 48-72 hours and

irrigation.

Recurrence rate: 6.

Ohba et al243

(2012)

Retrospective

observational study


High


hematomas. Managed with one burr hole craniostomy. 177 had closed

system drainage for 24 hours, 13

had irrigation, and 177 had bed rest for 24 hours.


recurrence: 1.

Pahatouridis et

al244 (2012)

Retrospective

observational study


High



89 with one burr hole. 245 had

drains for 48 hours and irrigation.

Recurrence rate: one burr hole: 5, two

burr holes: 9.

Safain et al245

(2013)

Prospective

observational study


High


hematomas. 23 managed with percutaneous twist drill drainage

and 23 with burr hole craniostomy

Mortality: percutaneous: 1,

traditional: 2/22. Cure rate: percutaneous: 20, traditional: 20.

Recurrence: percutaneous: 2,

26

or craniotomy (traditional). 23 had


traditional: 0, managed with burr

hole. Second recurrence: 0.

Singla et al246

(2012)

Retrospective

observational

study


High


hematomas. 19 used antiplatelets

and 12 used anticoagulants. Managed with percutaneous twist

drill drainage. 52 had subdural

evacuating system drainage for 24-48 hours. 0 had bed rest.


(pneumocephalus), 5 (seizure), 1

(acute epidural hematoma), 4 (acute subdural hematoma), 2 (pneumonia),

1 (multi-organ failure). Good

recovery: 38. Recurrence rate: 4, 3 managed with percutaneous drainage

and 1 with craniotomy.

Stanisic et al247

(2013)

Prospective

observational

study


High



one burr hole craniostomy. 107 had drainage and irrigation.


Tugcu et al248

(2013)

Retrospective

observational study


High





Yadav et al249

(2013)

Prospective

observational

study


High



percutaneous twist drill drainage. 50 had drainage and 0 had irrigation.

Mortality: 0. Recurrence rate: 7,

managed with burr holes. Second

recurrence: 0.

Almenawer et al250 (2013)


study



burr hole craniostomy, 204 with

two burr holes, 354 with percutaneous twist drill drainage,

and 57 with dexamethasone alone.

102 had adjuvant corticosteroids. 219 had drains. 204 had irrigation.

219 had bed rest.

Mortality: burr hole: 31 (16 one burr hole [with drainage], 15 two burr

holes [with irrigation]), percutaneous

drainage: 18 (6 adjuvant corticosteroid, 12 without adjuvant

corticosteroid), dexamethasone: 4.

Morbidity: burr hole: 64 (31 one burr hole [with drainage], 33 two burr hole

[with irrigation]), percutaneous

drainage: 45 (14 with adjuvant corticosteroid, 31 without adjuvant

corticosteroid), dexamethasone: 6.

Good recovery: burr hole: 360 (198 one burr hole [with drainage], 162

two burr holes [with irrigation]),

percutaneous drainage: 315 (91 with adjuvant corticosteroid, 254 without

adjuvant corticosteroid),

dexamethasone: 50. Recurrence rate: burr hole: 62 (30 one burr hole [with

drainage], 32 two burr holes [with

irrigation]), percutaneous drainage: 43 (14 with adjuvant corticosteroid,

29 without adjuvant corticosteroid),

dexamethasone: 6, managed with two burr holes. Second recurrence: 14.

Newcastle-Ottawa Scale quality assessment of observational studies results were based on the authors’ judgment about measuring comparability,

selection of cohorts, and assessment of outcomes. It was considered high if > 4 points and low if ≤ 4 points.

27

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34

Cochrane tool risk of bias assessment

35

Summary of the evidence (GRADE)1

Comparison Outcome Finding Quality of the evidence

(GRADE)

Percutaneous twist drill drainage

vs

Burr hole craniostomy

Craniotomy

vs


Corticosteroids

vs


Drains use

vs

No drainage

Irrigation

vs

No irrigation

Adjuvant corticosteroids use

vs

No steroids

One

vs

Two burr holes

Bed rest

vs

Activity as tolerated

Recurrence

Mortality

Mortality Cure rate

Recurrence Mortality

Morbidity

Cure rate

Recurrence

Mortality Morbidity

Cure rate

Recurrence

Mortality

Morbidity Cure rate


Morbidity Cure rate


Morbidity

Cure rate

Recurrence

Mortality Morbidity

Cure rate

Recurrence

Mortality

Morbidity Cure rate

No statistical difference


No statistical difference No statistical difference

Favours craniotomy No statistical difference

Favours percutaneous drainage





Favours drains use






Favours no steroids use








High ⊕⊕⊕⊕

High ⊕⊕⊕⊕

High ⊕⊕⊕⊕

High ⊕⊕⊕⊕

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Very low ⊕⊝⊝⊝




High ⊕⊕⊕⊕

High ⊕⊕⊕⊕

High ⊕⊕⊕⊕

High ⊕⊕⊕⊕

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Moderate ⊕⊕⊕⊝




Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝


Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

Low ⊕⊕⊝⊝

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect.

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of

effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of

effect and is likely to change the estimate.

Very low quality: We are very uncertain about the estimate.

1Summary of the evidence as obtained from GRADE profiler 3.6 based on the authors’ judgment about the overall

evidence. Detailed Relative Risks (RRs), Confidence Intervals (CIs), heterogeneity (I2), pooled proportions, P

values, number of participants, and total number of included studies for variable outcomes were described in

different tables of the manuscript.

Description of the 250 eligible studiesdownload.lww.com/wolterskluwer_vitalstream_com/PermaLink/SLA/A/SLA... · 1 Description of the 250 eligible studies Author/ Year Study Design

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