Subdural evacuating port system for chronic subdural hematoma: a systematic review and meta-analysis of clinical outcomes

Chronic subdural hematoma (cSDH) is a collection of old blood in the subdural space and has a relatively high estimated incidence, especially among the elderly and men, possibly due to falls, anticoagulant use, or age as independent factors. The subdural evacuating port system (SEPS) offers a minimally invasive solution for cSDH treatment. The objective of our meta-analysis is to review the literature and assess the safety and efficacy of SEPS as a first-line treatment for cSDH. We conducted an exhaustive literature search to explore outcomes resulting from the implementation of SEPS as the initial treatment for cSDH. The main focus was on treatment success, comprising both symptom improvement and the absence of additional operating room interventions. Supplementary outcomes encompassed factors such as discharge arrangements, length of hospital stay (LOS), recurrence of hematoma, and any associated complications. A total of 15 studies, involving 1146 patients who underwent SEPS placement, satisfied the inclusion criteria. The combined rate of achieving a successful outcome stood at 0.79 (95% CI 0.75–0.83). The occurrence of delayed hematoma recurrence was found to be 0.155 (95% CI 0.101–0.208). Meanwhile, the aggregated inpatient mortality rate was 0.017 (95% CI 0.007–0.031). In terms of complications, the rates were 0.02 (95% CI 0.00–0.03) for any acute hemorrhage, 0.01 (95% CI 0.00–0.01) for acute hemorrhage necessitating surgery, and 0.02 (95% CI 0.01–0.03) for seizures. Notably, SEPS placement is associated with a success rate of 79% and exceptionally low incidences of acute hemorrhage and seizure. SEPS is a viable first-line treatment for cSDH, supported by its minimally invasive nature, avoidance of general anesthesia, high success rate, and favorable safety profile.