Relevance about the use of dexametasone in a patient with chronic suddural hematoma: a literature review

Abstract

Introduction: The use of corticosteroids, especially dexamethasone, for the treatment of Chronic Subdural Hematoma (CSDH), is a secular conduct protocol. However, recent studies contradict this recommendation in some points. Objectives: To score the use of dexamethasone in patients with Chronic Subdural Hematoma. Methodology: Literature review, based on PubMed database using the descriptors “Desamethasone”, “Chronic Subdural Hematoma” and “Treatment”, using a time filter from the years 2020-2021. Results: In a study with 443 neurosurgeons, 26.2% of respondents estimate that corticosteroids are highly effective in CSDH, with 46.2% using dexamethasone as monotherapy in conservative treatment. According to a randomized study conducted by The New England Journal, 375 people diagnosed with CSDH were treated with dexamethasone while 373 received the placebo, where 94% had undergone surgical treatment previously. At the end of the study, only 680 candidate patients continued to be analyzed, of which a favorable outcome was seen in 286 of 341 (83.9%) in the dexamethasone group and in 306 of 339 patients (90.30) in the placebo group, where there is a difference of 6.4 percentage points in favor of the placebo. In addition, in the same study, more adverse effects occurred in the dexamethasone group, however, 1.7% of the patients in this group needed surgery for hematoma recurrence compared to 7.1% in the group that used the placebo. Conclusion: It is possible to say that treatment with dexamethasone caused more adverse effects and resulted in less favorable outcomes, however, the recurrence for the number of surgeries was lower.