Efficacy of membranectomy for the treatment of chronic subdural hematoma: an updated meta-analysis

Abstract Background Chronic subdural hematoma is a prevalent neurosurgical condition that necessitates surgical intervention. However, initial management remains controversial. This meta-analysis aimed to determine the benefits of Membranectomy when performed in conjunction with other neurosurgical interventions. Methods A systematic search was conducted in four electronic databases (PubMed, Cochrane Library, Web of Science, and Scopus) for eligible comparative studies until January 2024. Five primary outcomes were assessed. OpenMeta[Analyst] software was utilized for data analysis, and a p -value ≤ 0.05 was considered statistically significant. Results This meta-analysis encompassed 16 studies involving 2243 patients. The combined mean mortality, major complications, and reoperation rates were 6.9% (95% CI: 3.1–10.8%, p < 0.001), 17.5% (95% CI: 11.3–23.7%, p < 0.001), and 13.3% (95% CI: 7.7–18.5%, p < 0.001), respectively. The collective mean recurrence rate was 15.3% (95% CI: 10.2–20.3%, p < 0.001). Additionally, the collective mean length of hospital stay was 30.7 days (95% CI: 19.02–42.29, p < 0.001). Conclusion While membranectomy may reduce recurrence rates of CSDH in some cases, it is linked to higher mortality, complications, reoperations, and more extended hospital stays. Variability in techniques and patient factors complicates interpretation, and the retrospective nature of most studies limits definitive conclusions. Hence, membranectomy may benefit select patients, but its risks must be carefully considered. Further large-scale RCTs are needed to determine its safety and efficacy.