Surgery After Primary Dexamethasone Treatment for Patients with Chronic Subdural Hematoma—A Retrospective Study

Holl, Dana C; Fakhry, Rahman; Dirven, Clemens M.F.; Braake, Florien A L Te; Begashaw, Orit K; Moudrous, Walid; Droger, S Mirjam; Asahaad, Nabil; Brabander, Christiaan de; Plas, Gerben J. J.; Jacobs, Bram; Naalt, Joukje van der; Hertog, Heleen M. den; Gaag, Niels A. van der; Jellema, Korné; Dammers, Rúben; Lingsma, Hester F.

doi:10.1016/j.wneu.2022.03.014

Cited by 9 publications

(19 citation statements)

References 38 publications

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“…1 ). Full text was screened for 36 studies, of which 26 studies were excluded with reasons 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 and 10 studies were included 1 36 37 38 39 40 41 42 43 44 in the systematic review and meta-analysis ( Tables 1 2 3 ). The characteristics of the included studies are shown in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

“…4 Dexamethasone was used in the current study to assess its efficacy as a stand-alone therapy for the treatment of cSDH and its effect on the requirement for further surgery. 38 In total, 594 individuals who got dexamethasone alone as the primary therapy for cSDH were included in the study's systematic review and meta-analysis of 35 trials. 38 More than one-third of the patients receiving dexamethasone needed further surgery, according to the findings.…”

Section: Discussionmentioning

confidence: 99%

“…40 However, further studies did not support the findings. 38 The emerging results could not be established as high-grade evidence in multiple systematic reviews due to high selection bias and significant heterogeneity in the individual primary research studies.…”

Section: Discussionmentioning

confidence: 99%

“…This entails conducting prospective studies with larger cohorts. 21,24,25,[36][37][38][39][40][41]43 Considering the numerous research on the efficacy of dexamethasone for cSDH, while dexamethasone may provide favorable results for a major proportion of patients, a significant number of people still require different surgical surgery. Larger hematoma size, higher midline shift, and statin usage have been linked to an increased risk of surgery.…”

Section: Groupsmentioning

confidence: 99%

“…More research, including larger sample size prospective studies, is required to validate these findings and establish optimal treatment strategies for cSDH. 21,24,[37][38][39][40][41] Finally, a personalized therapy strategy that considers patient-specific characteristics will be critical for improving outcomes in cSDH patients.…”

Section: Groupsmentioning

confidence: 99%

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How Dexamethasone Affects Necessity for Surgical Intervention for Chronic Subdural Hematoma: Systematic Review and Meta-Analysis

Agrawal,

Gupta,

Mishra

et al. 2024

Indian Journal of Neurotrauma

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The effectiveness of dexamethasone in managing chronic subdural hematoma (cSDH) patients remains uncertain although the drug is widely used in this condition. The present systematic review aims to understand the role of dexamethasone in reducing the need for surgery in cSDH patients. This study was conducted as per the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the electronic databases of PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (the Cochrane Library), and ScienceDirect with a predefined search strategy. The population consisted of cSDH patients older than 18 years and treated primarily with dexamethasone. The primary outcome was the need for surgery after dexamethasone therapy in cSDH patients. The meta-analysis of a group of patients was done with the invariance method to estimate the pooled odds of the requirement for surgery after dexamethasone therapy. In the studies with a one-to-one comparison of dexamethasone with placebo/observation, the Mantel–Haenszel statistics were used to determine the odds of surgery. The quality of the studies was assessed with the Newcastle–Ottawa scale (NOS) and the Cochrane risk of bias tool was used to assess the risk of bias in randomized studies. In total, 598 studies were obtained from the database search and after applying the inclusion and exclusion criteria, 10 studies were finally selected for the qualitative and quantitative synthesis. One of the 10 studies was a randomized controlled trial (RCT), while the rest were observational studies. There were 653 patients who received the primary dexamethasone therapy. Of these, 388 patients did not require surgery, while 256 needed surgeries after the therapy. The pooled estimate of requirement for surgery after dexamethasone therapy was 0.41, with a 95% confidence interval of 0.37 to 0.45. A meta-analysis of the one-to-one comparison from three included studies showed a higher need of surgery in the (comparator) placebo/observation group than in the dexamethasone group with odds ratio of 7.16 (95% confidence interval: 2.21–23.13, with p = 0.0001). In addition, we identified the gaps in literature, and the complications and mortality reported in the studies. Dexamethasone is effective in reducing the requirement for surgery in some selected cSDH cases, although many patients still require surgical intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Groupsmentioning

confidence: 99%

Section: Groupsmentioning

confidence: 99%

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How Dexamethasone Affects Necessity for Surgical Intervention for Chronic Subdural Hematoma: Systematic Review and Meta-Analysis

Agrawal,

Gupta,

Mishra

et al. 2024

Indian Journal of Neurotrauma

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Additional treatment after primary conservative treatment in patients with chronic subdural hematoma—A retrospective study

Fakhry,

Dirven,

Moudrous

et al. 2024

Brain and Behavior

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ObjectiveChronic subdural hematoma (CSDH) is a common neurological condition and is typically treated with burr hole craniostomy. Nevertheless, conservative treatment may lead to spontaneous hematoma resolution in some patients. This study aims to describe the characteristics of patients who were treated conservatively without the eventual need for additional treatment.MethodsData were retrospectively collected from patients who were primarily treated conservatively in three hospitals in the Netherlands from 2008 to 2018. The Primary outcome was the nonnecessity of additional treatment within 3 months after the initial CSDH diagnosis. We used univariable and multivariable logistic regression analyses to identify factors associated with not receiving additional treatment.ResultsIn this study, 83 patients were included and 61 patients (73%) did not receive additional treatment within 3 months. Upon first presentation, the patients had a Markwalder Grading Scale score (MGS) of 0 (n = 5, 6%), 1 (n = 43, 52%), and 2 (n = 35, 42%). Additional treatment was less often received by patients with smaller hematoma volumes (adjusted odds ratio [aOR] 0.78 per 10 mL; 95% confidence interval [CI] 0.64–0.92). Patients using antithrombotic medication also received less additional treatment, but this association was not significant (aOR 2.02; 95% CI 0.61–6.69).ConclusionsThree quarters of the initially conservatively treated CSDH patients do not receive additional management. Typically, these patients have smaller hematoma volumes. Further, prospective research is needed to distinguish which patients require surgical intervention and in whom primary conservative treatment suffices.

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2022

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Surgery After Primary Dexamethasone Treatment for Patients with Chronic Subdural Hematoma—A Retrospective Study

Cited by 9 publications

References 38 publications

How Dexamethasone Affects Necessity for Surgical Intervention for Chronic Subdural Hematoma: Systematic Review and Meta-Analysis

How Dexamethasone Affects Necessity for Surgical Intervention for Chronic Subdural Hematoma: Systematic Review and Meta-Analysis

Additional treatment after primary conservative treatment in patients with chronic subdural hematoma—A retrospective study

Dexamethasone

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