Burr hole craniostomy vs. minicraniotomy of chronic subdural hematoma: a systematic review and meta-analysis

- OBJECTIVE: Surgery is the main-stay of treatment for chronic subdural hemato-ma (CSDH). However, the best surgical method is still controversial. Three different methods in-cluding burr hole craniostomy (BHC), minicraniotomy (MC), and twist drill craniostomy (TDC) are commonly utilized. Besides, large cra-niotomy, trephine craniotomy [TC (single or dou-ble)], small craniotomy, and endoscopic remov-al are befittingly used in some situations, too. Hence, we performed a systematic review and meta-analysis to compare the effects between BHC and MC for surgical treatment in CSDH. MATERIALS AND METHODS: A literature re-search was conducted according to the PRISMA (the Preferred Reporting Items for Systematic Re-views and Meta-Analyses) guidelines for studies that directly compared BHC and MC for CSDH. The following endpoints were compared between BHC and MC: recurrence rate, reoperation rate, duration of operation, days of hospital treatment, postoperative complications, mortality, and rate of good outcome. RESULTS: Thirteen papers [n = 3,559 (3,580 operation sites), BHC: 1,936 operation sites, MC: 1,644 operation sites] met the inclusion criteria. The recurrence rate (OR: 0.56, 95% CI: 0.34-0.91, p = 0.02; I2 = 66%) was lower and the reoperation rate was also significantly lower (OR: 0.45, 95% CI: 0.25-0.81, p = 0.008; I2 = 72%) in the BHC group compared with the MC group. The duration of operation (MD:-20.15 min, 95% CI:-28.99 to-11.31, p < 0.00001; I2 = 0%) was significantly shorter in the BHC group compared with the MC group. Nevertheless, there was no statistically significant difference between the two groups in mortality (OR: 1.22, 95% CI: 0.92-1.61, p = 0.16; I2 = 38%), postoperative complica-tions (OR: 0.68, 95% CI: 0.033-1.37, p = 0.28; I2 = 82%), days of hospital treatment (MD: 1.59, 95% CI:-10.44 to 13.62, p = 0.14; I2 = 85%) and rate of good outcome (OR: 1.40, 95% CI: 0.94-2.08, p = 0.10; I2 = 0%). CONCLUSIONS: A systematic review and me-ta-analysis of the included literature showed that BHC reduces the recurrence rate, reopera-tion rate and duration of operation compared to MC. BHC is much more minimal invasive when compared to MC. More invasions may signify more post-operative complications, which may cause the increasing rate of recurrence and re -operation. No significant difference in mortali-ty, post-operative complications, days of hospi-tal treatment and rate of good outcome was ob-served between the two groups.