Single vs. double burr hole craniostomy in surgical treatment of chronic subdural hematoma: A meta-analysis.

OBJECTIVES: Chronic subdural hematomas (cSDH) are one of the most common illness in the department of neurosurgery worldwide. As for the surgical procedure, some doctors prefer to single burr hole craniostomy (SBHC), however, other neurosurgeons like double burr hole craniostomy (DBHC). In this article, we conduct a meta-analysis to research whether DBHC increase the risk of recurrence, complication and mortality in cSDH patients compared with SBHC. METHODS: The retrospective observational trial or randomized controlled trial (RCT) studies concerning burr hole craniostomy treat cSDH were systematically identified through electronic database (PubMed, Web of Science, Embase and Cochrane). Inclusion and exclusion criteria were defined for the eligible studies. The random fixed effect model was performed when heterogeneity was indicated, otherwise a fixed effect model was adopted. RESULTS: This meta-analysis included 12 studies and 3 of them are RCT studies. Firstly, SBHC did not increase the risk of recurrence in patients with cSDH compared with DBHC (odds ratio (OR) of 1.28, 95% confidence interval (CI), 0.92-1.78, P=0.07). Secondly, DBHC did not increase complication rate in patients with cSDH compared with SBHC (OR of 0.74, 95%CI, 0.20-2.76, P=0.11). Thirdly, DBHC did not increase mortality in cSDH patients compared with SBHC (OR of 1.38, 95%CI, 0.55-3.46, P=0.58). CONCLUSION: This meta-analysis demonstrated that SBHC has no significant difference with DBHC in treatment of cSDH patients, through compared the recurrence rate, complication rate and morbidity between the two surgical techniques.