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Dexamethasone for chronic subdural haematoma: a systematic review and meta-analysis

  • Review Article - Brain Injury
  • Published:
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Abstract

Background

Chronic subdural haematoma is a common but retractable neurological disease in the elderly with a high rate of recurrence. Dexamethasone (DX) either as monotherapy or adjuvant therapy has been applied clinically, but its effectiveness and feasibility remain controversial. We conducted this review to clarify this issue.

Methods

With a systematic review through multiple databases, we retrieved eligible English language publications and extracted relevant data to perform meta-analyses. The respective risk ratio (RR) and its 95% confidence interval (CI) were pooled to evaluate the overall effect.

Results

Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference on recurrence rate between DX alone and non-DX therapy or surgical therapy (RR, 0.86; 95% CI, 0.43-1.71; p = 0.66) (RR, 0.89; 95% CI, 0.43-1.85; p = 0.76). Comparison between DX alone with the surgical therapy demonstrated no difference on the poor outcome (RR, 0.40; 95% CI, 0.15-1.04; p = 0.06).

Conclusions

We had no enough evidence to support DX use as an effective alternation to surgical therapy. But adjuvant DX use may facilitate the surgical therapy by reducing recurrence. Further study focusing on adjuvant DX was required.

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Funding

This work was funded by Science and Technology Supportive Project of Sichuan Province (No. 2015SZ0051) and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (No. ZY2016102).

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Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University and West China Brain Research Centre, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China

    Zhong Yao, Xin Hu, Lu Ma & Chao You

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  1. Zhong Yao
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  2. Xin Hu
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  3. Lu Ma
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Correspondence to Chao You.

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Yao, Z., Hu, X., Ma, L. et al. Dexamethasone for chronic subdural haematoma: a systematic review and meta-analysis. Acta Neurochir 159, 2037–2044 (2017). https://doi.org/10.1007/s00701-017-3309-7

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  • DOI: https://doi.org/10.1007/s00701-017-3309-7

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