Single versus double burr-hole drainage for chronic subdural hematoma: a systematic review and meta-analysis of 2,359 patients.

BACKGROUND: CSDH is one of the most common neurosurgical conditions in older adults. Burr-hole craniostomy remains the standard surgical treatment; however, the optimal number of burr holes remains controversial. This systematic review and meta-analysis aimed to compare recurrence rates following SBHC versus DBHC in patients with CSDH. METHOD: A systematic search of PubMed/MEDLINE and Scopus was conducted. Comparative studies evaluating SBHC versus DBHC for adult CSDH were included. The primary outcome was recurrence requiring reoperation. Random-effects meta-analyses were performed. Heterogeneity, sensitivity analyses, subgroup analyses, meta-regression, and publication bias assessments were conducted. RESULTS: Nineteen studies involving 2,359 patients were included, comprising 1,249 patients treated with SBHC and 1,110 with DBHC. Overall recurrence occurred in 10.1% of patients, including 11.5% in the SBHC group and 8.6% in the DBHC group. Pooled analysis demonstrated no statistically significant difference in recurrence between techniques (OR 1.29, 95% CI 0.84-1.99; p = 0.234). Similar findings were observed using RR (1.24, 95% CI 0.86-1.79) and RD (1.46%, 95% CI - 2.31% to 5.22%). Moderate heterogeneity was present (I2 = 33%). Excluding studies with recurrence-modifying co-interventions strengthened the effect estimate toward DBHC (OR 1.44, 95% CI 0.99-2.08; p = 0.061) while reducing heterogeneity (I2 = 16%). CONCLUSION: Single and double burr-hole craniostomy provide comparable recurrence outcomes in the surgical management of chronic subdural haematoma. Although a non-significant trend favored DBHC, current evidence supports individualized surgical decision-making. Adequately powered randomized trials controlling for adjunctive interventions are needed to clarify any potential advantage of DBHC.