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Comparative efficacy of dexamethasone versus surgery for chronic subdural hematoma: A systematic review and
Areeba Shoaib1, Fariha Arif1, Maryam Khan1
1Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Insights
Dexamethasone (DXM) monotherapy for chronic subdural hematoma (CSH) showed no mortality difference versus surgery but a higher need for repeat surgery. Outcomes were similar, though DXM offered shorter hospital stays.
Area of Science:
- Neurosurgery
- Pharmacology
- Clinical Trials
Background:
- Chronic subdural hematoma (CSDH) is a significant neurosurgical condition.
- Surgical evacuation remains the gold standard treatment for CSDH.
- Dexamethasone (DXM) has emerged as a potential non-surgical therapeutic option.
Purpose of the Study:
- To compare the efficacy and safety of dexamethasone (DXM) monotherapy against surgical intervention for chronic subdural hematoma (CSDH).
- To evaluate mortality, secondary surgical intervention rates, and clinical outcomes in CSDH patients treated with DXM versus surgery.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, PubMed, EMBASE, Cochrane) up to September 2023.
- A meta-analysis was performed on 6 studies involving 704 patients comparing surgery with DXM monotherapy for CSDH.
- Data on mortality, secondary surgery, and clinical outcomes at different time points were extracted and analyzed.
Main Results:
- No statistically significant difference in mortality was observed between the surgery and DXM groups (RR=1.09; P=0.83).
- DXM monotherapy was associated with a significantly higher incidence of secondary surgical intervention (RR=4.24; P<0.0001).
- No significant differences were found in poor outcomes within the hospital stay or at 6 months post-treatment.
Conclusions:
- While DXM monotherapy did not increase mortality or negatively impact other safety outcomes compared to surgery for CSDH, it led to a higher rate of secondary surgical interventions.
- Observational data suggested potential benefits of DXM, including lower risk of poor outcomes and shorter hospital stays, but surgery demonstrated a lower recurrence rate.
Objective:
To assess the comparative efficacy of dexamethasone (DXM) as monotherapy in comparison to surgery among the patients of chronic subdural hematoma (CSDH).
Methods:
We searched MEDLINE, PUBMED, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception till September 2023. Data was extracted, pooled and analyzed from all the studies that assessed the comparative efficacy of DXM as monotherapy in contrast with surgery as the primary treatment of CSDH.
Results:
A total of 6 studies involving 704 patients were included in our meta-analysis. Comparison of surgery to DXM revealed there was no statistically significant difference between the two groups regarding mortality [RR=1.09; 95% CI; 0.52-2.28 P = 0.83]. However, a significantly higher incidence of secondary surgical intervention was observed in the DXM group [RR 4.24; 95% CI; 2.06-8.71 P < 0.0001]. No significant difference in performance was observed in terms of poor postoperative outcomes within hospital stay [RR 1.12, 95% CI, 0.40-3.19 P=0.83] and at 6 months [RR 0.92, 95%CI, 0.40-2.13 P=0.85].
Conclusion:
DXM had a significantly higher incidence of secondary surgical intervention. However, there was no difference regarding mortality and other safety outcomes between surgery and DXM for the patients with CSDH. Observational studies showed that DXM was associated with a lower risk of poor postoperative outcomes within hospital stay and had shorter duration of hospital stay, but the recurrence rate was lower in the surgery group.
