Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis

Holl, Dana C; Volovici, Victor; Dirven, Clemens M.F.; Kooten, Fop van; Miah, Ishita P.; Jellema, Korné; Peul, Wilco C.; Gaag, Niels A. van der; Kho, Kuan H.; Hertog, Heleen M. den; Dammers, Rúben; Lingsma, Hester F.

doi:10.1007/s00701-019-03881-w

Cited by 49 publications

(39 citation statements)

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“…In a meta-analysis the adjuvant use of Dexamethasone resulted in a lower recurrence rate if compared with non-Dexametasone therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01) (12). Moreover, no additional complications or morbidity appeared to be associated with corticosteroid treatment in this setting (15). The mechanism of action of corticosteroids in CSDH has been associated to the inhibition of the formation granulation tissue, responsible for the creation of a capsule surrounding the hematoma and containing numerous newly formed, permeable capillaries, which could be responsible for recurrent bleeding (22,(35)(36)(37).…”

Section: Discussionmentioning

confidence: 84%

“…Whether age and sex have an influence on the rates of recurrence after surgery for CSDH evacuation is debated, with some reports suggesting older age and male sex to be at higher risk (2) and others with opposite findings (14). In another series, a median age of 78 (interquartile range 70-84) for patients who did not have a recurrence has been highlighted, compared to a median age of 80 (76-87) for patients who did (15). Though such finding was statistically significant, it is arguable that a 2-year difference in age is not clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

et al. 2020

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Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear.Objective: To identify factors associated with increased risk of recurrence.Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes.Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013).Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

et al. 2020

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“…7 Systematic reviews have concluded that glucocorticoids may be safe and effective when used in addition to surgery, with the aim of reducing the risk of recurrence, or as stand-alone therapy, with the aim of avoiding surgery. 8,9 However, there is limited evidence from multicenter, randomized trials to assess the effects of glucocorticoids on outcomes. We conducted a multicenter, randomized, placebocontrolled trial to assess the effect of dexamethasone on outcomes in patients with symptomatic chronic subdural hematoma.…”

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confidence: 99%

Trial of Dexamethasone for Chronic Subdural Hematoma

Hutchinson¹,

et al. 2020

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document.When citing, please reference the published version. Take down policyWhile the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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“…Furthermore, up to 25% recurrence rate is reported. Glucocorticoid has been used to treat CSDH [5], with acceptable efficacy and safety profile as stand-alone therapy to avoid surgery or as an adjunct to surgery to prevent recurrence of subdural fluid collection [6,7]. The Dexamethasone for Adult Patients with Symptomatic Chronic Subdural hematoma (Dex-CSDH) trial was a multicenter, randomized control trial conducted in the United Kingdom and published in December 2020 [8].…”

Section: Introductionmentioning

confidence: 99%

The Role of Dexamethasone in the Era of “Dex-CSDH” Randomized Controlled Trial. A Multicenter, Prospective Study on Specific Subset of Patients with Chronic Subdural Hematoma (CSDH) Treated with Dexamethasone Alone or Surgery

Chaturbedi

2021

JHNSS

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Background:The efficacy of Dexamethasone as a method of conservative management for CSDH to avoid surgery remains inconclusive even after "Dex-CSDH" randomized controlled trial as almost all patients underwent an initial operation to remove the hematoma. Current study aims to determine the efficacy and safety of Dexamethasone alone therapy in comparison with the surgical drain of CSDH. Methods:A multicenter, prospective study on mild to moderately symptomatic adult patients with CSDH were performed from January 2019 to December 2020. The patients were enrolled in a 1:1 ratio to receive a 3-weeks tapering course of oral Dexamethasone, starting at 4 mg thrice daily, or surgical drain of CSDH. The patient was assigned to a particular therapy based on their preference. The primary outcome was functional outcome in each group at 6 months determined by mRS, and cure rate (symptomatic relief and radiological resolution of CSDH).Results: Twenty eights patients were assigned to Dexamethasone group and 30 patients to surgical group. The mean age of the patient was about 62 years in both groups with male predominance (>60%). A favorable outcome determined by mRS scale of 1 to 3 at 6 months follow-up was 25/28 (89.2%) in Dexamethasone group compared to 28/30 (93.3%) in surgical group (difference, -4.1 [95% CI, -6.8 to -2.2], p=0.12). The cure rate was 23/28 (82.1%) in Dexamethasone group compared to 28/30 (93.3%) in the surgical group during index admission (difference, [95% CI,] in favor of the surgical group, p=0.005). Recurrence rate for CSDH was 2/28 (7.1%) in Dexamethasone group compared to surgical group 4/30 (13.3%) which was statistically significant (p=0.01). Morbidity related to medical therapy was not statistically higher compared to surgical group. Conclusion:Current study exhibits superiority of surgery over Dexamethasone therapy for resolution of symptomatic CSDH. The recurrence rate of CSDH is lower in patients with corticotherapy compared to surgical drain. Patients in Dexamethasone group did not have functional outcome at 6 months or morbidity significantly higher than surgical group. This study strongly puts forward the utility of Dexamethasone as an effective and safe alternative to surgery for CSDH.

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Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis

Cited by 49 publications

References 50 publications

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

Trial of Dexamethasone for Chronic Subdural Hematoma

The Role of Dexamethasone in the Era of “Dex-CSDH” Randomized Controlled Trial. A Multicenter, Prospective Study on Specific Subset of Patients with Chronic Subdural Hematoma (CSDH) Treated with Dexamethasone Alone or Surgery

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