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Surgery After Primary Dexamethasone Treatment for Patients with Chronic Subdural Hematoma-A Retrospective Study
Dana C Holl1, Rahman Fakhry2, Clemens M F Dirven2
1Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.
Insights
Over a third of patients with chronic subdural hematoma (CSDH) treated with dexamethasone required further surgery. Factors like larger hematoma size and specific imaging characteristics predicted the need for surgical intervention in these CSDH cases.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Chronic subdural hematoma (CSDH) is a significant neurological condition.
- Dexamethasone is increasingly used as a primary treatment for CSDH.
- Quantifying the need for subsequent surgery after dexamethasone treatment is crucial for patient management.
Purpose of the Study:
- To determine the rate of additional surgery required in patients with CSDH primarily treated with dexamethasone.
- To identify patient-specific characteristics and CSDH features associated with the need for further surgical intervention.
Main Methods:
- Retrospective analysis of 283 CSDH patients treated with dexamethasone across three hospitals (2008-2018).
- Primary outcome: need for additional surgery.
- Statistical analysis included univariable and multivariable logistic regression to identify associated factors.
Main Results:
- Over one-third (37.8%) of patients required additional surgery.
- Factors associated with increased odds of surgery included higher Markwalder Grade, statin use, larger midline shift, greater hematoma thickness, bilateral, and separated hematomas.
- Antithrombotic use and trabecular hematoma characteristics were associated with a lower likelihood of surgery.
Conclusions:
- A substantial proportion of CSDH patients treated with dexamethasone necessitate additional surgical procedures.
- Patient characteristics, particularly those indicating more severe disease like larger hematoma dimensions and specific imaging patterns, are linked to the need for surgery.
Background:
We aimed to quantify the need for additional surgery in patients with chronic subdural hematoma (CSDH) primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery.
Methods:
Data were retrospectively collected from 283 patients with CSDH, primarily treated with dexamethasone, in 3 hospitals from 2008 to 2018. Primary outcome was the need for additional surgery. The association between baseline characteristics and additional surgery was analyzed with univariable and multivariable logistic regression analysis and presented as adjusted odds ratios (aOR).
Results:
In total, 283 patients with CSDH were included: 146 patients (51.6%) received 1 dexamethasone course (DXM group), 30 patients (10.6%) received 2 dexamethasone courses (DXM-DXM group), and 107 patients (37.8%) received additional surgery (DXM-SURG group). Patients who underwent surgery more often had a Markwalder Grading Scale of 2 (as compared with 1, aOR 2.05; 95% confidence interval [CI] 0.90-4.65), used statins (aOR 2.09; 95% CI 1.01-4.33), had a larger midline shift (aOR 1.10 per mm; 95% CI 1.01-1.21) and had larger hematoma thickness (aOR 1.16 per mm; 95% CI 1.09-1.23), had a bilateral hematoma (aOR 1.85; 95% CI 0.90-3.79), and had a separated hematoma (as compared with homogeneous, aOR 1.77; 95% CI 0.72-4.38). Antithrombotics (aOR 0.45; 95% CI 0.21-0.95) and trabecular hematoma (as compared with homogeneous, aOR 0.31; 95% CI 0.12-0.77) were associated with a lower likelihood of surgery.
Conclusions:
More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.
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