Subperiosteal versus Subdural Drainage in Burr-Hole Trepanation for Chronic Subdural Hematomas: A Meta-Analysis

Abstract

Abstract Background Chronic subdural hematoma (CSDH) is a common neurological disorder in older patients, and immediate outcomes of surgery for CSDH are satisfactory. However, the evidence for subperiosteal drainage (SPD) versus subdural drainage (SDD) in CSDH remains controversial. In this study, we aimed to assess the latest evidence on the use of SPD versus SDD in patients with CSDH who underwent burr hole evacuation. Methods We performed a systematic literature search on the use of SPD compared with that of SDD in patients with CSDH in PubMed, Web of Science, Embase, and Cochrane online databases from inception until December 2021. The inclusion and exclusion criteria were defined for eligible studies. A fixed-effects model was used when homogeneity was observed. Results A total of 1013 participants from six studies were included. There were no significant differences in the recurrence rate (odds ratios [OR], 0.87; 95% confidence interval [CI], 0.61–1.26; I2 = 0%; P = 0.47) or the mortality rate (P = 0.89) between the SPD and SDD groups. Additionally, various characteristics, including the rate of subsequent seizures (P = 0.74), sex distribution (P = 0.37), and favorable clinical outcome rates (OR, 1.13; 95% CI, 0.74–1.72; I2 = 0%; P = 0.58), were also similar between the two groups. Moreover, there was no significant difference in the effects of antithrombotic agents between the two groups (P = 0.12). Conclusions There were no differences in recurrence rates, sex distribution, postoperative mortality, seizures, favorable outcomes (modified Rankin scale score: 0–3), or effects of antithrombotic agents between the SPD and SDD groups. These findings suggest that both SPD and SDD are equally effective in treating patients with CSDH.