Chronic Subdural Hematoma in Nigeria: Systematic Review and Meta-analysis

Abstract

Background: Chronic subdural hematoma (CSDH) is an increasingly recognised condition in Nigeria, yet systematic data on its epidemiology, clinical presentation, treatment, and outcomes are scarce. This systematic review and meta-analysis aimed to synthesize the available evidence on CSDH in Nigeria, including its epidemiology, clinical features, treatment outcomes, and recurrence rates, and to evaluate the efficacy of different treatment modalities. Methods: A systematic review was conducted following PRISMA guidelines, encompassing studies on CSDH in Nigeria published between 1962 and 2025. Databases and grey literature were searched, and articles were screened and selected independently by two reviewers. Data were extracted using a standardized template. Results: Of 819 articles identified, 14 studies (13 observational, 1 RCT) involving 1315 patients met the inclusion criteria. Mild head trauma was the predominant aetiology (68.0%), with right-sided CSDH more common (62.3%). The most frequent surgical approach was single burr hole drainage (59.7%), with drainage employed in 99.3% of interventions. The recurrence rate was significant (21.6%; p<0.001). Meta-analysis revealed a pooled mean age at diagnosis of 59.1 years and a male predominance (82.0%). Patients commonly presented with a combination of headache, loss of consciousness, and hemiparesis in 53.0% of cases (in 8 studies with 333 patients), whilst 83.0% of patients in 5 other studies with 406 patients had intracranial hypertension, cognitive decline, and loss of consciousness. Despite statistical significance in pooled outcomes, heterogeneity was noted across studies.  Conclusion: This systematic review and meta-analysis reveals that CSDH in Nigeria is primarily caused by mild trauma, with single burr-hole evacuation and drainage being the preferred treatment. However, high recurrence rates persist, underscoring the need for further research into prevention and standardized management protocols to improve outcomes.