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Impact of adjunctive steroids on chronic subdural hematoma treated with surgery and MMAE: A propensity-matched study
Vishal V Thakur1, Jesse McClure1, David Fletcher2
1Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA.
Insights
Adjunctive steroid therapy in chronic subdural hematoma (cSDH) patients undergoing surgery and middle meningeal artery embolization (MMAE) showed no benefit. Steroids did not improve outcomes and may increase readmission and mortality risks.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Medical Research
Background:
- Chronic subdural hematoma (cSDH) treatment often involves surgical evacuation and middle meningeal artery embolization (MMAE).
- The role of adjunctive steroid therapy in patients receiving both cSDH treatments remains uninvestigated.
- This study addresses the impact of steroids in this specific clinical scenario.
Purpose of the Study:
- To evaluate the efficacy and safety of adjunctive steroid therapy.
- To compare outcomes in cSDH patients treated with surgery, MMAE, and steroids versus those without steroids.
- To determine if steroids improve outcomes or increase risks in this combined treatment approach.
Main Methods:
- Retrospective, multi-institutional, multi-national study utilizing the TriNetX platform.
- Propensity score matching was employed to compare patients with and without adjunctive steroid therapy.
- Primary outcomes included unplanned readmissions, repeat surgery rates, and six-month mortality.
Main Results:
- 605 cSDH patients were analyzed; 283 received steroids.
- No significant differences in primary outcomes (readmission, repeat surgery, mortality) were found between steroid and non-steroid groups post-matching.
- The steroid group showed a non-significant trend toward higher readmission and mortality rates.
Conclusions:
- Adjunctive steroid therapy offers no clear benefit for cSDH patients treated with both surgical evacuation and MMAE.
- Steroid use in this context may not be warranted and could potentially increase patient risks.
- Further research may be needed to confirm these findings and guide clinical practice.
Background:
The impact of steroid use in patients with chronic subdural hematoma (cSDH) treated with both surgical evacuation and middle meningeal artery embolization (MMAE) has not been previously reported. This study compares outcomes in this specific patient population.
Methods:
We conducted a multi-institutional, multi-national, retrospective, propensity score-matched study using the TriNetX platform. Patients with cSDH who underwent both surgical evacuation and MMAE were included and stratified based on whether they received adjunctive steroid therapy. Primary outcomes included unplanned inpatient readmissions, need for repeat surgery, and six-month mortality.
Results:
A total of 605 cSDH patients met the inclusion criteria, of whom 283 received adjunctive steroids. After propensity score matching, no significant differences were observed in the primary outcomes between patients who received steroids and those who did not. However, the steroid group exhibited non-significantly higher rates of inpatient readmission and mortality.
Conclusion:
In patients with cSDH treated with a combination of surgical evacuation and MMAE, adjunctive steroid therapy was not associated with improved outcomes. These findings suggest that steroids may not confer a clear benefit in this setting and could potentially expose patients to unnecessary risks.
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