• Inamullah Khan, Muhammad Shakir, Busha Hika, Musharaf Khan, Ibrahim Ahmad Bhatti, Adnan I Qureshi, Ajith Thomas, Peter Kan, and Farhan Siddiq.
• Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA. Electronic address: ikkhf@health.missouri.edu.
• World Neurosurg. 2024 Sep 6.

BackgroundConservative treatments for minimally symptomatic chronic subdural hematoma (cSDH) are debated, with surgery as the primary option.ObjectiveTo assess failure rates of a conservative approach for management of cSDH.MethodsWe searched PubMed, SCOPUS, Web of Science, and ClinicalTrials.gov for studies on conservative management of cSDH and analyzed the data using R (version 4.1.2).ResultsA total of 35 studies including 2095 patients were analyzed: 950 (45%) of the patients were in the observation group, 671 (32%) in the corticosteroid group, 355 (17%) in the atorvastatin group, 43 (2%) in the mannitol group, 52 (2.5%) in the tranexamic acid group, and 24 (1.1%) in the etizolam group. Our pooled analysis showed that 19.82% of patients required rescue surgery (95% confidence interval [CI]: 12.98% to 26.66%, P < 0.0001). The overall pooled risk ratio (RR) for the effect of interventions on the need for rescue surgery was 0.2424 (95% CI: 0.1577 to 0.3725, Iˆ2 = 90.5%, P < 0.0001). Subgroup analysis showed varied effects: observation group (RR = 0.3482, 95% CI: 0.1045 to 1.1609, Iˆ2 = 94.0%), corticosteroids (RR = 0.2988, 95% CI: 0.1671 to 0.5344, Iˆ2 = 90.8%), atorvastatin (RR = 0.1609, 95% CI: 0.0985 to 0.2627, Iˆ2 = 53.2%), mannitol (RR = 0.0370, 95% CI: 0.0009 to 1.5244), and tranexamic acid (RR = 0.0585, 95% CI: 0.0026 to 1.2924).ConclusionsThe rate of rescue surgery in conservatively managed cSDH patients remains high. Corticosteroids or atorvastatin demonstrates some potential benefit in reducing the failure rate but collective effectiveness is unknown.Copyright © 2024 Elsevier Inc. All rights reserved.

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