Comparison of different surgical techniques for chronic subdural hematoma: a network meta-analysis

Background Chronic subdural hematoma (CSDH) is a neurosurgical condition with high prevalence. Many surgical approaches are recommended for treating CSDH, but there needs to be consensus on the optimal technique. This network meta-analysis (NMA) compared efficacy and safety of different treatments CSDH. Methods Electronic databases, including PubMed, Embase, Cochrane Library, were searched relevant studies up February 2023. An NMA was performed compare outcomes patients CSDH treated by single-hole or double-hole craniotomy (SBHC DBHC, respectively), twist-drill (TDC), mini-craniotomy, craniotomy. The protocol registered at INPLASY (registration no. 202320114). Results included 38 7,337 patients. For outcomes, DBHC showed highest surface under cumulative ranking area (SUCRA) values recurrence (96.3%) reoperation (87.4%) rates. differed significantly from mini-craniotomy in rate (odds ratio [OR] = 0.58, 95% confidence interval [CI]: 0.35, 0.97) SBHC (OR 0.48, CI: 0.25, 0.91) TDC 0.40, 0.20, 0.82) rate. operative time, superior (mean difference [MD] −2.32, −3.78 −0.86), (MD −3.61, −5.55, −1.67), −3.39, −5.70, −1.08). Patients had shorter hospital stay than those −0.82, −1.51, −0.12). no significant differences between groups mortality complication rates; however, (79.8%) (78.1%) SUCRAs. Conclusion may most effective treatment based low rates, although all examined techniques relatively safe. Systematic review registration https://inplasy.com/inplasy-2023-2-0114/