Neurosurgery 96:922–936, 2025
The meta-analysis evaluates surgical interventions for acute subdural hematoma, comparing craniotomy and decompressive craniectomy. It finds similar mortality and functional outcomes in matched cohorts, despite worse baseline parameters in craniectomy patients. The study emphasizes the need for future trials to validate these findings.
• Acute Subdural Hematoma (ASDH) requires urgent surgical intervention, typically through craniotomy (CO) or decompressive craniectomy (DC).
• Meta-analysis included 18 studies with 8886 patients, assessing functional outcomes and mortality rates between CO and DC.
• Functional outcomes showed similar Glasgow Outcome Scale-Extended (GOSE) scores between CO and DC, but Glasgow Outcome Scale (GOS) scores favored CO.
• Mortality analysis indicated lower short-term mortality for CO, but similar long-term mortality between CO and DC in matched cohorts.
• Complications and reoperation rates were comparable between CO and DC, with cerebrospinal fluid diversion more common in DC.
• Quality of Life (QOL) was not thoroughly assessed due to differences in measurement tools and limited data.
• The study highlights the need for further clinical trials to validate findings and address gaps in existing literature
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