Steroid in Chronic Subdural Hematoma: An Updated Systematic Review and Meta-Analysis Post DEX-CSDH Trial

Shrestha, Dhan Bahadur; Budhathoki, Pravash; Sedhai, Yub Raj; Jain, Sameer; Karki, Pearlbiga; Jha, Pinky; Mainali, Gaurab; Ghimire, Prajwal

doi:10.1016/j.wneu.2021.10.167

Cited by 19 publications

(25 citation statements)

References 26 publications

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“…Nausea and vomiting are common, and hemiplegia is rare. It is considered that bilateral hemorrhage leads to the relative balance of bilateral cerebral hemisphere compression, and the probability of midline deviation is small [ 20 , 21 ]. For bilateral CSDH, some studies suggest that bilateral simultaneous decompression should be given as soon as possible, and even cases with only mild neurological deficit should be actively treated.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Bilateral Chronic Subdural Hematoma

Zhuang

Jiang

Zhou

et al. 2022

Computational Intelligence and Neuroscience

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Background. Chronic subdural hematoma (CSDH) is one of the common clinical intracranial hemorrhagic disorders, accounting for 16%–20% of bilateral CSDH. At present, the surgical treatment of bilateral CSDH mainly includes drilling drainage and neuroendoscopic assistance. The main objective of this paper was to compare the effects of two surgical methods on CSDH. Methods. 153 patients who were diagnosed with CSDH were included in this study. 79 patients were treated with bilateral drilling drainage, and the other 74 patients were treated with neuroendoscope-assisted drainage. The clinical data of the two groups were compared, and the surgical indexes, neurological function, cure rate, and recurrence rate of the two groups were compared. The operation indexes of patients include operation time, postoperative hematoma volume, hospital stay, extubation time, misplacement of drainage tube, recurrence, and hematoma clearance rate. Results. All patients underwent CT examination one day after operation. The CT imaging detection of the two groups was generally good. The cranial CT was reexamined before discharge. The bilateral hematoma disappeared in 114 patients, the unilateral hematoma disappeared in 29 patients, a small amount of compensatory crescent very low-density shadow subdural effusion was observed on the other side, and a small amount of compensatory crescent very low-density shadow subdural effusion was observed on both sides in 10 patients. There was no space occupying effect and intracranial gas disappeared. Compared with neuroendoscopic assisted drainage, the operation time of drilling drainage patients was significantly shorter. The extubation time, drainage tube dislocation, recurrence rate, postoperative hematoma volume, and hematoma clearance rate of patients receiving neuroendoscopic assisted drainage were significantly better than those receiving drilling drainage. The Markwalder score and hospital stay between the two groups were not significant. Conclusions. Drilling drainage and neuroendoscopic assisted surgery have good therapeutic effects on bilateral CSDH. The operation time of drilling drainage is shorter. Neuroendoscopic assisted surgery has more advantages in extubation time, misplacement of drainage tube, recurrence, postoperative hematoma volume, and hematoma clearance rate.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Bilateral Chronic Subdural Hematoma

Zhuang

Jiang

Zhou

et al. 2022

Computational Intelligence and Neuroscience

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“…Meanwhile, glucocorticoid, especially dexamethasone, has been used to manage CSDH. Recent meta-analysis after the DEX-CSDH trial had shown some benefits in terms of recurrence but no benefit in terms of mortality with significantly higher adverse events [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery in Chronic Subdural Hematoma: Prognosis and Recurrence Factors of 516 Cases in a Single Center

Tan

Wang

et al. 2022

JCM

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Objective: To investigate the effects of minimally invasive surgery (MIS) using a novel YL-1 puncture needle and summarize the risk factors of recurrence in chronic subdural hematoma (CSDH). Methods: We performed a retrospective analysis in 516 hospitalized patients with CSDH from January 2013 to December 2018 in Northern Jiangsu People’s Hospital. Patients’ gender, age, history of trauma, use of anticoagulants, history of disturbed liver or renal function, history of heart disease, history of malignant tumor, history of diabetes, hemodialysis, coagulopathy, alcoholism, imaging indicators, and postoperative application of urokinase or atorvastatin were recorded. Recurrence is defined by imaging examination with or without clinical presentation three months after discharge. Results: In total, 483 patients (93.60%) benefited from MIS by YL-1 needle. Gender, age, history of head trauma, history of disturbed liver function, history of heart disease, history of malignant tumor, history of diabetes, history of hemodialysis, coagulopathy, alcoholism, hematoma location, hematoma densities, septum formation, maximum thickness, encephalatrophy, and use of atorvastatin and urokinase were shown to be non-significantly associated with postoperative recurrence (p > 0.05). The use of anticoagulants was significantly associated with postoperative recurrence (p > 0. 05). Logistic analysis showed that the use of anticoagulants is an independent factor predicting postoperative recurrence (p > 0. 05). Conclusions: The novel YL-1 puncture needle turned out to be a safe and effective minimally invasive surgery, and the use of anticoagulants is an independent risk factor predicting postoperative recurrence in CSDH, which can provide MIS and early therapeutic strategies for neurosurgeons.

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“…Although intracranial hypotension in elderly patients cannot be compensated by MMA embolization, the recurrence rate should be reduced if the inflammation resolved. [5] MMA embolization is an optimal option for this purpose [3] as is the oral intake of corticosteroids [23] and Goreisan extract. [8] Endoscopic observation would help a limited number of patients with CSDH in providing information for the treatment of choice.…”

Section: Whitementioning

confidence: 99%

“…e mass lesion and symptoms spontaneously turn to the resolution phase, which is promoted by corticosteroids. [23] e active healing processes of CSDH are observed and staged by histopathology, [9,18] CT, [19,20,25] and endoscopy. [13,26] Nagahori et al [18] classified the histopathological findings of the outer membrane into four stages: I, noninflammatory; II, inflammatory; III, hemorrhagic inflammatory; and IV, scar inflammatory stages.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopically observed outer membrane of chronic subdural hematoma after endovascular embolization of middle meningeal artery

Nomura¹,

Haji²,

Fujiyama³

et al. 2022

Surgical Neurology International

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Background: Embolization of the middle meningeal artery (MMA) has been established for chronic subdural hematoma (CSDH). Neuroendoscopic observation of the outer membrane of the hematoma was carried out after embolization. The treatment mechanism of embolization is discussed, focusing on the vasculature and inflammation of the membrane. Methods: Four patients with recurrent CSDH were included in this study. The MMA was embolized using Embosphere® particles in three patients. The outer membrane was observed with normal and narrow band images (NBIs). Results: The net-like vessels were not obstructed in the whole area of the outer membrane, but in a patchy fashion of embolized areas surrounded by nonembolized areas. In two patients, the nonembolized areas showed a hemorrhagic inflammatory red color. Histopathological examination confirmed hypertrophic dura with leukocyte infiltration. Dilated dural arteries and proliferated sinusoid arteries were located in the deep and superficial border cell layers. These arteries were visualized as green and brown on NBI, respectively. In the embolized area, the red membrane turned pink, indicating ischemia and subsiding inflammatory hyperemia. In the third patient, the outer membrane was white in both the nonembolized and embolized areas in endoscopic view, and the net-like vessels were sparse in both endoscopy and histology, indicating a scar inflammatory phase. The membrane transition was not observed in the patient that did not undergo embolization. Conclusion: Endoscopic observation revealed that embolization of the MMA blocked both the dural and sinusoidal arteries. Ischemic transformation causing the suppression of inflammation of the outer membrane is a suggested mechanism of MMA embolization.

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Steroid in Chronic Subdural Hematoma: An Updated Systematic Review and Meta-Analysis Post DEX-CSDH Trial

Cited by 19 publications

References 26 publications

Surgical Treatment of Bilateral Chronic Subdural Hematoma

Surgical Treatment of Bilateral Chronic Subdural Hematoma

Minimally Invasive Surgery in Chronic Subdural Hematoma: Prognosis and Recurrence Factors of 516 Cases in a Single Center

Endoscopically observed outer membrane of chronic subdural hematoma after endovascular embolization of middle meningeal artery

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