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Effects of Dexamethasone in the Treatment of Recurrent Chronic Subdural Hematoma
Yu Zhang1, Shiping Chen1, Yangchun Xiao1
1Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Insights
Dexamethasone offers a safe and effective non-surgical treatment for recurrent chronic subdural hematoma (CSDH). This approach can help patients avoid reoperation and achieve good functional recovery.
Area of Science:
- Neurosurgery
- Neurology
- Pharmacology
Background:
- Recurrent chronic subdural hematoma (CSDH) presents a significant clinical challenge.
- Dexamethasone has shown promise in managing chronic subdural hematoma, but its efficacy in recurrent cases requires systematic evaluation.
Purpose of the Study:
- To assess the efficacy and safety of dexamethasone in treating patients with recurrent CSDH.
- To compare dexamethasone treatment with surgical intervention for recurrent CSDH.
Main Methods:
- Retrospective review of 27 patients with symptomatic recurrent CSDH (July 2010 - September 2014).
- Patients received either burr hole surgery or dexamethasone treatment.
- Follow-up included imaging (CT/MRI) to monitor hematoma resolution, complications, and outcomes.
Main Results:
- 17 out of 24 patients (70.8%) treated with dexamethasone achieved successful medical resolution, avoiding reoperation.
- Complications in the dexamethasone group were low (12.5%), including hyperglycemia, UTI, and pneumonia.
- Functional recovery was high (87.5%) in patients treated with dexamethasone, with no significant difference compared to surgery.
Conclusions:
- Dexamethasone is a safe and effective nonsurgical option for recurrent CSDH.
- Medical management with dexamethasone can potentially prevent the need for reoperation in recurrent CSDH patients.
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.
