Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | https://repositorio.unifesp.br/handle/11600/58616 https://doi.org/10.1016/j.wneu.2015.10.025 |
Resumo: | BACKGROUND: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. OBJECTIVE: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. - METHODS: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. RESULTS: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burrhole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34-0.66, P < 0.00001) with no other clear benefits or complications. CONCLUSIONS: This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burrhole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions. |
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Ivamoto, Henrique Seiji [UNIFESP]Lemos Jr., Hernani Pinto [UNIFESP]Atallah, Alvaro Nagib [UNIFESP]2020-11-03T14:40:33Z2020-11-03T14:40:33Z2016World Neurosurgery. New York, v. 86, p. 399-418, 2016.1878-8750https://repositorio.unifesp.br/handle/11600/58616https://doi.org/10.1016/j.wneu.2015.10.025WOS000369625300075.pdf10.1016/j.wneu.2015.10.025WOS:000369625300075BACKGROUND: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. OBJECTIVE: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. - METHODS: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. RESULTS: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burrhole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34-0.66, P < 0.00001) with no other clear benefits or complications. CONCLUSIONS: This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burrhole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.Univ Fed Sao Paulo, Postgrad Program Evidence Based Hlth Care, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Postgrad Program Evidence Based Hlth Care, Brazilian Cochrane Ctr, Sao Paulo, BrazilWeb of Science399-418engElsevier Science IncWorld NeurosurgeryChronic subdural hematomaEvidence-based medicineOperative surgical proceduresRandomized controlled trialsSurgical treatments for chronic subdural hematomasSystematic reviewSurgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Reviewinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleNew York86info:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/586162022-02-10 21:23:38.124metadata only accessoai:repositorio.unifesp.br:11600/58616Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-05-25T12:12:14.166312Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review |
title |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review |
spellingShingle |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review Ivamoto, Henrique Seiji [UNIFESP] Chronic subdural hematoma Evidence-based medicine Operative surgical procedures Randomized controlled trials Surgical treatments for chronic subdural hematomas Systematic review |
title_short |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review |
title_full |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review |
title_fullStr |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review |
title_full_unstemmed |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review |
title_sort |
Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review |
author |
Ivamoto, Henrique Seiji [UNIFESP] |
author_facet |
Ivamoto, Henrique Seiji [UNIFESP] Lemos Jr., Hernani Pinto [UNIFESP] Atallah, Alvaro Nagib [UNIFESP] |
author_role |
author |
author2 |
Lemos Jr., Hernani Pinto [UNIFESP] Atallah, Alvaro Nagib [UNIFESP] |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Ivamoto, Henrique Seiji [UNIFESP] Lemos Jr., Hernani Pinto [UNIFESP] Atallah, Alvaro Nagib [UNIFESP] |
dc.subject.eng.fl_str_mv |
Chronic subdural hematoma Evidence-based medicine Operative surgical procedures Randomized controlled trials Surgical treatments for chronic subdural hematomas Systematic review |
topic |
Chronic subdural hematoma Evidence-based medicine Operative surgical procedures Randomized controlled trials Surgical treatments for chronic subdural hematomas Systematic review |
description |
BACKGROUND: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. OBJECTIVE: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. - METHODS: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. RESULTS: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burrhole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34-0.66, P < 0.00001) with no other clear benefits or complications. CONCLUSIONS: This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burrhole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions. |
publishDate |
2016 |
dc.date.issued.fl_str_mv |
2016 |
dc.date.accessioned.fl_str_mv |
2020-11-03T14:40:33Z |
dc.date.available.fl_str_mv |
2020-11-03T14:40:33Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
World Neurosurgery. New York, v. 86, p. 399-418, 2016. |
dc.identifier.uri.fl_str_mv |
https://repositorio.unifesp.br/handle/11600/58616 https://doi.org/10.1016/j.wneu.2015.10.025 |
dc.identifier.issn.none.fl_str_mv |
1878-8750 |
dc.identifier.file.none.fl_str_mv |
WOS000369625300075.pdf |
dc.identifier.doi.none.fl_str_mv |
10.1016/j.wneu.2015.10.025 |
dc.identifier.wos.none.fl_str_mv |
WOS:000369625300075 |
identifier_str_mv |
World Neurosurgery. New York, v. 86, p. 399-418, 2016. 1878-8750 WOS000369625300075.pdf 10.1016/j.wneu.2015.10.025 WOS:000369625300075 |
url |
https://repositorio.unifesp.br/handle/11600/58616 https://doi.org/10.1016/j.wneu.2015.10.025 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
World Neurosurgery |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
399-418 |
dc.coverage.none.fl_str_mv |
New York |
dc.publisher.none.fl_str_mv |
Elsevier Science Inc |
publisher.none.fl_str_mv |
Elsevier Science Inc |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
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Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
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