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Adjuvant Corticosteroids With Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis
Min Shi1, Ling-Fei Xiao2, Ting-Bao Zhang1
1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Insights
Adjuvant corticosteroids with surgery significantly reduce chronic subdural hematoma recurrence. However, this treatment does not improve mortality or functional outcomes compared to surgery alone, warranting further research.
Area of Science:
- Neurosurgery
- Pharmacology
- Evidence-Based Medicine
Background:
- Chronic subdural hematoma (CSDH) management often involves surgical intervention.
- The role of adjuvant corticosteroids in CSDH surgery remains debated due to inconclusive evidence on efficacy and safety.
Purpose of the Study:
- To conduct a meta-analysis and systematic review evaluating the effectiveness and safety of adjuvant corticosteroids in CSDH surgery.
- To synthesize findings from randomized controlled trials and observational studies.
Main Methods:
- Comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science databases up to May 2021.
- Inclusion of nine studies (3 RCTs, 6 observational studies) comparing adjuvant corticosteroids plus surgery versus surgery alone.
- Assessment of outcomes including recurrence rate, mortality, functional outcome, hospitalization length, and adverse events.
Main Results:
- Adjuvant corticosteroids significantly reduced CSDH recurrence risk (RR = 0.52, 95% CI = 0.39-0.69, p < 0.00001).
- No significant differences were found in all-cause mortality (RR = 0.91), good functional outcome (RR = 1.03), hospitalization length (MD = 0.35), or infection rates (RR = 0.99).
Conclusions:
- Adjuvant corticosteroids with CSDH surgery effectively decrease recurrence rates.
- Current evidence does not support improved mortality or functional outcomes with adjuvant corticosteroids compared to surgery alone.
- Further high-quality randomized controlled trials are needed to confirm efficacy and safety.
Abstract:
The use of adjuvant corticosteroids with surgery for chronic subdural hematoma (CSDH) has received considerable attention in recent years. However, there is no conclusive evidence regarding its effectiveness and safety for CSDH. Therefore, we performed a meta-analysis and systematic review to evaluate the effectiveness and safety of corticosteroids as an adjuvant treatment for the treatment of CSDH. We comprehensively searched electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) to identify relevant trials that investigated the efficacy and safety of adjuvant corticosteroids with surgery for CSDH, published from inception until May 2021. Outcome measures included recurrence rate, all-cause mortality, good functional outcome, length of hospitalization, and adverse events. We used the Cochrane risk of bias method to evaluate the quality of randomized controlled trials (RCTs), and the Newcastle Ottawa Scale to evaluate the quality of observational studies. We included nine studies, consisting of three RCTs and six observational studies, that compared corticosteroids as an adjuvant treatment to surgery with surgery alone. Pooled results revealed that the risk of recurrence was significantly reduced in patients who received adjuvant corticosteroids with surgery compared to those who underwent surgery alone (relative risk [RR] = 0.52, 95% confidence interval [CI] = 0.39-0.69, p < 0.00001). However, no statistically significant difference was observed between these groups in all-cause mortality (RR = 0.91, 95% CI = 0.37-2.23, p = 0.83), good functional outcome (RR = 1.03, 95% CI = 0.96-1.10, p = 0.47), length of hospitalization (MD = 0.35, 95% CI = -2.23 to 1.67, p = 0.83), and infection rates (RR = 0.99, 95% CI = 0.64-1.53, p = 0.95). Adjuvant corticosteroids with surgery reduce the risk of recurrence of CDSH, but do not improve the all-cause mortality or functional outcome, as compared to surgery alone. These findings support the use of adjuvant corticosteroids with surgery for CSDH patients. Further high-quality RCTs are required to confirm the efficacy and safety of adjuvant corticosteroids in the treatment of CSDH patients.
