Chronic subdural hematoma (cSDH) is a common neurosurgical condition that can cause severe morbidity and mortality. cSDH recurs after surgical evacuation in 5–30% of patients, but drains may help reduce this risk. We aimed to investigate the effect of drainage versus no drainage on the rates of recurrence and mortality, as well as the clinical outcomes of cSDH. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to June 2022. Using Review Manager software, we reported four primary outcomes as odds ratios (ORs) and confidence intervals (CIs). The meta-analysis included a total of 10 studies with 1961 patients. The use of drainage was found to be significantly more effective than non-drainage in reducing the “mortality rate” (OR = 0.65, 95% CI 0.43 to 0.97; P = 0.04), the “recurrence rate” (OR = 0.39, 95% CI 0.28 to 0.55; P < 0.00001), and occurrence of “gross focal neurological deficit” (OR = 0.58, 95% CI 0.37 to 0.89; P = 0.01). No significant difference was found in the occurrence of a Glasgow Coma Scale score of 15 (OR = 1.21, 95% CI 0.84 to 1.76; P = 0.30). The use of drains after burr-hole irrigation reduces the recurrence, mortality, and gross focal neurological deficit rates of chronic subdural hematomas.

Background: Chronic subdural hematoma (CSDH) is a prevalent type of intracranial hemorrhage. Surgical interventions, such as Twist Drill Craniostomy and Burr Hole Craniostomy, are employed for its treatment. However, limited information exists regarding the impact of postoperative head position (supine vs. elevated) on clinical outcomes. We aim to assess whether patients’ head position after surgery influences their prognosis. Method: We conducted a PRISMA-compliant systematic review and meta-analysis. Our search encompassed PubMed, Cochrane CENTRAL, Scopus, Web of Science, and Embase databases to identify relevant published studies. Data were meticulously extracted, pooled using a fixed model, and reported as risk ratios (RR) with 95% confidence intervals (CI). Statistical analysis was performed using R and Stata MP v.17. Results: Five studies involving 284 patients were included in our meta-analysis. We focused on three primary clinical outcomes, comparing the supine and elevated header positions. Notably, there was no statistically significant difference between the supine and elevated positions in terms of recurrence rate (RR 0.77, 95% CI [0.44, 1.37]), second intervention for recurrence (RR 1.07, 95% CI [0.42, 2.78]) and postoperative complications (RR 1.16, 95% CI [0.70, 1.92]). Conclusion: Current studies have proved no difference between supine and elevated bed header positions regarding recurrence rate, second intervention for recurrence, and postoperative complications. Future RCTs with long-term follow-ups are recommended.

Introduction: Stroke is a leading cause of morbidity and mortality worldwide, with limited effective treatment options. Fingolimod has been shown to have neuroprotective effects in previous studies and has been approved for use in multiple sclerosis. This systematic review aims to evaluate the current evidence regarding the efficacy of Fingolimod in cerebrovascular stroke.Methods: A comprehensive literature search was conducted using electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) for studies published up to January 2023. Studies were included if they evaluated the efficacy of Fingolimod in subjects with cerebrovascular stroke and reported outcomes.Results: This meta-analysis included six studies with a total of 251 patients, 124 in the fingolimod group and 127 in the control group. Fingolimod was associated with significant improvements in NIHSS scores on days 7, 14, 30, and 90 post-stroke, with the greatest improvement seen after one month (MD = -7.1, 95% CI [-9.73, -4.65], P < 0. 00001). Additionally, fingolimod was associated with significant reductions in mRS scores after three months (MD = 7.3, 95% CI [3.06, 17.40], P < 0. 00001) and significant improvements in Modified Barthel Index scores on days 7, 14, 30, and 90 post-stroke. After three months, the mean difference in Modified Barthel Index scores was 14.6 (95% CI [5.80, 23.36], P = 0.0005). Fingolimod was also associated with significant reductions in microvascular permeability ratio (rT%) and infarct volume (MD = -15.2, 95% CI [-23.33, -7.15], P < 0. 00001).Conclusion: The current evidence suggests that Fingolimod may have potential as a neuroprotective agent in cerebrovascular stroke. However, more high-quality clinical trials are warranted.