Elsevier

World Neurosurgery

Volume 105, September 2017, Pages 115-121
World Neurosurgery

Original Article
Effects of Dexamethasone in the Treatment of Recurrent Chronic Subdural Hematoma

https://doi.org/10.1016/j.wneu.2017.05.135Get rights and content

Objective

Recurrent chronic subdural hematoma (CSDH) is not rare. Some studies have demonstrated the role of dexamethasone in the medical management of chronic subdural hematoma. However, no systematic study in the treatment of recurrent CSDH has been published. The aim of our study is to evaluate the efficacy and safety of dexamethasone in patients with recurrent CSDH.

Methods

We retrospectively reviewed medical records of consecutive patients from July 2010 to September 2014. A total of 27 patients with symptomatic recurrent CSDH were included in the analysis. Follow-up for each patient consisted of computed tomography or magnetic resonance imaging every 28 days from admission to the resolution of hematoma. Data were collected on hematoma volume, complications, and outcome.

Results

Among the 27 patients, 3 patients with recurrent CSDH were only treated by burr hole surgery. Of the other 24 patients who primarily underwent dexamethasone treatment, 17 (70.8%) patients were treated successfully with medical treatment, whereas 7 patients required reoperation. Complications were noted in 3 (12.5%) patients (1 hyperglycemia, 1 urinary tract infection, and 1 pneumonia). There was 1 mortality (4.2%) for massive brain infarction. Twenty-one of the 24 patients (87.5%) recovered to their previous functional levels. There was no statistical significance in Fisher text between surgery and dexamethasone regarding success, complication, and functional recovery rate.

Conclusions

Patients with recurrent CSDH can be treated successfully and safely with the nonsurgical medical treatment of dexamethasone. By use of this method, reoperation may be avoided.

Introduction

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Perhaps the most important complication of CSDH is recurrence necessitating reoperation, which rates in the literature vary widely, from 5% to 30%.1, 2 However, reoperation is not only associated high mortality and morbidity3, 4, 5 but also results in significant unhappiness to the patient and his or her relative.6 Furthermore, CSDH increasingly occurs in older patients, who may have some severe diseases in their background, which adversely influences the operating prognosis of hematoma and carries a greater risk of perioperational complication.7 Thus, alternative and more conservative therapies may be necessary for nonemergency recurrent patients. There is increasing evidence that dexamethasone could be used in the treatment of mild CSDH, either as monotherapy or as an adjunct to surgical treatment. Apart from few case reports,8 however, there has not been any systematic study on dexamethasone treatment of recurrent CSDH. The aim of our study is to evaluate the efficacy and safety of dexamethasone in the medical treatment of recurrent CSDH.

Section snippets

Patient Population

We identified patients by retrospective analysis of the medical records and neuroradiographic studies for consecutive patients seen at the Department of Neurosurgery of our hospital between July 2010 and September 2014. Two neurosurgeons evaluated all imaging studies and clinical symptoms of each patient. The data were extracted from medical records and follow-up computed tomography (CT) scans. All patients who had surgical treatment for CSDH were identified. After the established surgical

Clinical Presentations

We included 27 recurrent patients with CSDH during the study period; 19 were men (70.4%) and 8 were women (30.0%), ranging from 46 to 92 years of age (average age, 68.3 years). Original surgery included 22 cases (81.4%) of burr hole craniostomy and 5 cases (18.5%) of twist drill craniostomy. Patients presented with headache (9 patients, 33.3%) and gait disturbance (12 patients, 44.4%) in most cases. Neurologic defects included confusion (7 patients, 26.0%), hemiparesis (7 patients, 25.9%),

Discussion

Our present retrospective data found a 70.8% success rate, a 12.5% complication rate, and an 87.5% recovery rate for patients with demonstrated treatment. Furthermore, there was no statistical significance between surgery and demonstrated treatment regarding these rates. However, this is not equal to no difference between the 2 treatments. Thus, we should compare our results with other studies regarding success, complication, and mortality rate. In the literature, between 5% and 30% of patients

Conclusions

Within the limitations of this retrospective analysis, the effectiveness, safety, and applicability of dexamethasone seem comparable with reoperation. In some patients, recurrent CSDH can be treated successfully with dexamethasone without reoperation. Consequently, by use of this method, reoperation was avoided.

References (19)

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Cited by (34)

  • Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study

    2019, Injury
    Citation Excerpt :

    Factors predicting the recurrence of CSDH have been documented in many studies, including age [2], male sex [2], antiplatelet and/or anticoagulant use [3–5], bilateral hematomas [6–9], midline shift [5,9,10], computed tomography (CT) density [3,11–15], preoperative hematoma volume [5,14,16,17], ways of subdural drainage [18], postoperative pneumocephalus [19,20], postoperative haematoma residual [4,10,12], patients with history of seizure, and diabetes mellitus [5,14]. Identifying risk factors for CSDH recurrence contributes to the postoperative management of the patients and therapeutic trials such as Dexamethasone, Atorvastatin and Goreisan [21–24]. However, there are penurious uniform parameters available to predict the recurrence of CSDH after surgery.

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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