Original ArticleEffects of Dexamethasone in the Treatment of Recurrent Chronic Subdural Hematoma
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.
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2021, NPG Neurologie - Psychiatrie - GeriatrieClinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study
2019, InjuryCitation 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.
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.