The outcome after surgical vs nonsurgical treatment of chronic subdural hematoma with dexamethasone

Fountas, Kostas N.; Kotlia, Polikceni; Panagiotopoulos, Vasilios; Fotakopoulos, George

doi:10.1016/j.inat.2018.12.011

Cited by 25 publications

(21 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 99%

“…20 In contrast, another study showed that patients have better outcomes when treated with surgery combined with corticosteroids. 21 Interim analysis of yet another trial suggests adjuvant dexamethasone can safely reduce recurrence. 22 In our study, patients receiving dexamethasone had lower recurrence rates and more adverse effects (Table-IV), both of which were not statistically significant.…”

Section: A H E a D O F P R I N Tmentioning

confidence: 99%

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Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome

Tariq

Bhatti

2021

Pak J Med Sci

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Objectives: To compare the effect of burrhole craniostomy with and without a postoperative course of dexamethasone on recurrence rate of chronic subdural hematoma (CSDH). Methods: The study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, from September 2017 till May 2018. Adult patients diagnosed with CSDH and advised burrhole craniostomy were enrolled in this prospective randomized controlled trial. Participants were randomized into Group-1 (receiving two weeks dexamethasone), and Group-2 (no dexamethasone). Clinical assessment and Brain CT were done preoperatively, second postoperative day, sixth and twelfth postoperative week, with outcome assessed at twelfth postoperative week. Complications of treatment and recurrence rate were recorded. Results: Ninety-two (n=92, 46 in each group) patients were enrolled. Improvement in neurological (95.7% vs 93.5%; P=0.646) and radiological outcome (95.7% vs 93.5%; P=0.646) was similar in both groups. Complication rate was higher in Group-1 but not significantly different (58.7% vs 43.5%; P=0.535). Most frequent complication was pneumocephalus, with mortality rate equal (n=one). Recurrence was observed in 2.2% (n=1/46) patients in Group-1 and 4.3% (n=2/46) in Group-2 (P=0.557), which was not statistically significant. Conclusions: Neurological and radiological outcome, and mortality rates were similar in both groups. The recurrence rate was lower and complications slightly higher in Group-1 but these were not statistically significant. doi: https://doi.org/10.12669/pjms.37.7.3374 How to cite this:Tariq J, Bhatti SN. Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3374 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Section: A H E a D O F P R I N Tmentioning

confidence: 99%

Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome

Tariq

Bhatti

2021

Pak J Med Sci

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“…Eleven studies investigated the role of DX. [13][14][15][16][17][18][19][20][21][22][23] We retrieved 1067 cases in which DX was administered: in 810 cases as adjuvant treatment, whereas 257 patients received DX as primary treatment. The cohorts that received DX alone showed the most unfavorable outcomes: surgical procedures for hematoma evacuation were required, ranging from 22% to 83% of patients in different series.…”

Section: Medical Treatments: Txa and DXmentioning

confidence: 99%

“…[14][15][16][17][18][19][20][21][22] On the other hand, adjuvant corticosteroids after surgery resulted in a recurrence rate of 11.6%, ranging from 0% to 40% among the different studies. 16,18,19,21,23 Endovascular Treatment: MMAE MMAE is a relatively new technique; it was first reported in the early 2000s. 24 It was performed in 195 patients for a total of 207 procedures: in 125 cases as adjuvant treatment for recurrence after surgery or as a prophylactic measure in patients with specific risk factors, such as coagulation disorders.…”

Section: Medical Treatments: Txa and DXmentioning

confidence: 99%

To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review

Scerrati

Visani

Ricciardi³

et al. 2020

Neurosurgical Focus

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OBJECTIVEChronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.METHODSThe authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were “chronic subdural hematoma,” “conservative treatment/management,” “pharmacological treatment,” “non-surgical,” “tranexamic acid,” “dexamethasone,” “corticosteroid,” “glucocorticoid,” “middle meningeal artery,” “endovascular treatment,” and “embolization.”RESULTSThe authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.CONCLUSIONSThe results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable.

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“…7,8,9 Currently, the management of CSDH may consist of surgery, a temporary high dose of corticosteroids as monotherapy or as an adjunct to surgery, or watchful waiting. 10…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence

Takroni

Zagzoog

Patel

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background/Objectives Chronic Subdural Hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH. Materials and Methods We retrospectively analyzed the charts of 180 CSDH patients treated with bedside twist drill craniostomy (TDC) and subdural drain insertion. Patients were divided into two groups: Group A (n=123) received our traditional drain (pediatric size nasogastric tube (NGT), while group B (n=49) had the external ventricular drain (EVD). Various demographic and radiological data were collected. Our main outcome was recurrence, defined as symptomatic re-accumulation of hematoma on the previously operated side within 3 months. Results 212 cases of subdural hematoma were treated in 172 patients. Majority of patients were male (78%) and had a history of previous head trauma (73%). 17 cases had recurrence, 11 in the NGT group drain and 6 in the EVD group. The use of antiplatelet or anticoagulation agents was associated with recurrence (P= 0.038 and 0.05, respectively). There was no difference between both groups in terms of recurrence [OR=1.42, 95% CI:0.49 to 4.08, P=0.573]. Conclusion Chronic subdural hematoma is a common disease with a high rate of recurrence. Although using a drain postoperatively has shown to improve the incidence of recurrence, little remains known about the best type of drain to use. Our analysis showed no difference in the recurrent rate between using the pediatric size NGT and the EVD catheter post TDC.

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The outcome after surgical vs nonsurgical treatment of chronic subdural hematoma with dexamethasone

Cited by 25 publications

References 22 publications

Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome

Adjunctive postoperative course of dexamethasone in chronic subdural hematoma: Effect on surgical outcome

To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review

Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence

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