Related Experiment Video
Updated: Jun 14, 2025
A Surgical Procedure for the Administration of Drugs to the Inner Ear in a Non-Human Primate Common Marmoset Callithrix jacchus
Published on: February 27, 2018
Medical management of chronic subdural hematoma with low-dose hydrocortisone: a case series
Muhammet Enes Gurses1,2, Meric Ulgen1, Elif Gökalp2,3
1Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Türkiye.
Insights
Low-dose hydrocortisone effectively treats chronic subdural hematomas (cSDH) in select patients, offering a safe alternative to surgery. This treatment demonstrated significant volume reduction and good patient outcomes without complications.
Area of Science:
- Neurosurgery
- Neurology
- Pharmacology
Background:
- Chronic subdural hematomas (cSDH) management often involves burr-hole craniostomy, carrying risks of mortality, morbidity, and recurrence.
- The efficacy and feasibility of steroid use for cSDH remain debated, necessitating further investigation into alternative treatments.
Purpose of the Study:
- To evaluate the safety and effectiveness of low-dose hydrocortisone for treating chronic subdural hematomas (cSDH).
- To assess hydrocortisone's impact on hematoma volume and patient outcomes in a retrospective patient series.
Main Methods:
- Retrospective review of patients treated with hydrocortisone for cSDH between 2017 and 2023.
- Data collection included demographics, clinical presentation, radiological findings, and treatment duration.
- Statistical analysis using paired t-tests to assess changes in hematoma volume over time.
Main Results:
- Eighteen patients met inclusion criteria, with a mean age of 78.5 years; most had mild symptoms or were unsuitable for surgery.
- Significant reductions in hematoma volume were observed at weeks 2, 1 month, and 3 months of treatment (p < 0.0001).
- No complications were reported, and post-treatment Karnofsky scores improved to 90-100, indicating good functional recovery.
Conclusions:
- Low-dose hydrocortisone is a safe and effective treatment option for chronic subdural hematomas (cSDH) in patients with asymptomatic, mild, or moderate symptoms.
- It is particularly beneficial for patients who are unsuitable for or decline surgical intervention.
- Treatment should be individualized, with hydrocortisone offering a viable conservative management strategy.
Abstract:
Chronic subdural hematomas (cSDH) are often managed with a burr-hole craniostomy and drainage, but surgery is associated with elevated mortality, morbidity, and recurrence. Despite reports of steroid use for such patients, its efficacy and feasibility are still debated. We present our patient series treated with low-dose hydrocortisone. We retrospectively reviewed data from patients treated with hydrocortisone between 2017 and 2023. Demographics, clinical and radiological data were collected. Of 27 patients identified, nine required a burr-hole craniotomy for an average volume of 120.23 cm3, average midline shift of 9 mm, and neurological deficits. Eighteen met the criteria for inclusion. The mean age was 78.5 years; 13 were male. None had severe symptoms requiring urgent intervention. Except for one with a Karnofsky Performance Scale score of 70, all could maintain normal activity before treatment. The mean baseline volume was 52.6 cm3. Midline shift, present in six, averaged 6.8 mm. Patients underwent treatment for an average of 5.15 months. Nine had complete resolution within 3 months, while nine required longer treatment, including one who needed 9 months for a re-bleed after a fall. Paired t-tests indicated significant reductions in hematoma volumes at the second week (p = 0.01), first month (p < 0.0001), and third month (p < 0.0001) of treatment. No complications occurred and the post-treatment Karnofsky scores ranged from 90 to 100. Treatment for cSDH should be tailored to the patient. Low-dose hydrocortisone is safe and effective in asymptomatic patients, those with mild to moderate symptoms, and those who are either unsuitable for or decline surgical intervention.
