Subdural evacuating port system for chronic subdural hematoma: a systematic review and meta-analysis of clinical outcomes

IF 0.7 Q4 CLINICAL NEUROLOGY
Muhammad Ashir Shafique, Muhammad Saqlain Mustafa, Abdul Haseeb, Naeemullah Arbani, Aashish Kumar, Subash Perkash, Abdul Raheem, Syed Muhammad Sinaan Ali
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Abstract

Chronic subdural hematoma (cSDH) is a collection of old blood in the subdural space and has a relatively high estimated incidence, especially among the elderly and men, possibly due to falls, anticoagulant use, or age as independent factors. The subdural evacuating port system (SEPS) offers a minimally invasive solution for cSDH treatment. The objective of our meta-analysis is to review the literature and assess the safety and efficacy of SEPS as a first-line treatment for cSDH. We conducted an exhaustive literature search to explore outcomes resulting from the implementation of SEPS as the initial treatment for cSDH. The main focus was on treatment success, comprising both symptom improvement and the absence of additional operating room interventions. Supplementary outcomes encompassed factors such as discharge arrangements, length of hospital stay (LOS), recurrence of hematoma, and any associated complications. A total of 15 studies, involving 1146 patients who underwent SEPS placement, satisfied the inclusion criteria. The combined rate of achieving a successful outcome stood at 0.79 (95% CI 0.75–0.83). The occurrence of delayed hematoma recurrence was found to be 0.155 (95% CI 0.101–0.208). Meanwhile, the aggregated inpatient mortality rate was 0.017 (95% CI 0.007–0.031). In terms of complications, the rates were 0.02 (95% CI 0.00–0.03) for any acute hemorrhage, 0.01 (95% CI 0.00–0.01) for acute hemorrhage necessitating surgery, and 0.02 (95% CI 0.01–0.03) for seizures. Notably, SEPS placement is associated with a success rate of 79% and exceptionally low incidences of acute hemorrhage and seizure. SEPS is a viable first-line treatment for cSDH, supported by its minimally invasive nature, avoidance of general anesthesia, high success rate, and favorable safety profile.
治疗慢性硬膜下血肿的硬膜下抽血孔系统:临床结果的系统回顾和荟萃分析
慢性硬膜下血肿(cSDH)是硬膜下间隙中陈旧血液的聚集,估计发病率相对较高,尤其是在老年人和男性中,这可能是由于跌倒、使用抗凝剂或年龄等独立因素造成的。硬膜下排空端口系统(SEPS)为治疗 cSDH 提供了一种微创解决方案。我们的荟萃分析旨在回顾文献,评估 SEPS 作为 cSDH 一线治疗方法的安全性和有效性。我们进行了详尽的文献检索,以探索将SEPS作为cSDH初始治疗方法所产生的结果。主要关注点是治疗的成功率,包括症状的改善和没有额外的手术室干预。补充结果包括出院安排、住院时间(LOS)、血肿复发和任何相关并发症等因素。共有 15 项研究符合纳入标准,涉及 1146 名接受 SEPS 置入术的患者。获得成功结果的综合比率为 0.79(95% CI 0.75-0.83)。延迟血肿复发率为 0.155(95% CI 0.101-0.208)。同时,住院病人的总死亡率为 0.017(95% CI 0.007-0.031)。在并发症方面,任何急性出血的并发症发生率为 0.02(95% CI 0.00-0.03),需要手术的急性出血的并发症发生率为 0.01(95% CI 0.00-0.01),癫痫发作的并发症发生率为 0.02(95% CI 0.01-0.03)。值得注意的是,SEPS 置入的成功率为 79%,急性出血和癫痫发作的发生率极低。SEPS 具有微创、无需全身麻醉、成功率高、安全性好等优点,是治疗 cSDH 的可行一线疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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