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Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis

  • Review Article - Brain trauma
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Abstract

Background

There is an ongoing debate on the role of corticosteroids in the treatment of chronic subdural hematoma (CSDH). This study aims to evaluate the effectiveness of corticosteroids for the treatment of CSDH compared to surgery.

Method

A systematic search was performed in relevant databases up to January 2019 to identify RCTs or observational studies that compared at least two of three treatment modalities: the use of corticosteroids as a monotherapy (C), corticosteroids as an adjunct to surgery (CS), and surgery alone (S). Outcome measures were good neurological outcome, need for reintervention, mortality, and complications. Effect estimates were pooled and presented as relative risk (RR) with 95% confidence interval (95%CI).

Results

Of 796 initially identified studies, 7 were included in the meta-analysis. Risk of bias was generally high. There were no differences in good neurological outcome between treatment modalities. The need for reintervention varied between 4 and 58% in C, 4–12% in CS, and 7–26% in S. The need for reintervention was lower in CS compared with C (RR 3.34 [95% CI 1.53–7.29]; p < 0.01) and lower in CS compared with S (RR 0.44 [95% CI 0.27–0.72]; p < 0.01). Mortality varied between 0 and 4% in C, 0–13% in CS, and 0–44% in S. Mortality was lower in CS compared with S (RR 0.39 [95% CI 0.25–0.63]; p < 0.01). There were no differences in complications between treatment modalities.

Conclusions

This meta-analysis suggests that the addition of corticosteroids to surgery might be effective in the treatment of CSDH. However, the results must be interpreted with caution in light of the serious risk of bias of the included studies. This study stresses the need for large randomized trials to investigate the use of corticosteroids in the management of CSDH.

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Acknowledgements

The authors would like to thank Wichor M. Bramer, information specialist at the Erasmus Medical Centre in Rotterdam, The Netherlands, for his assistance in the literature search. The authors are part of the Dutch Chronic Subdural Hematoma Research group (DSHR); which aims to unite Dutch CSDH-researchers.

Funding

The Netherlands Organisation for Health Research and Development (ZonMw project number 843002824) provided financial support in the form of funding. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Neurosurgery, Erasmus MC Stroke Centre, Erasmus Medical Centre, 2040, 3000 CA Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    Dana C. Holl, Victor Volovici, Clemens M. F. Dirven & Ruben Dammers

  2. Department of Public Health and Medical Decision Making, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    Victor Volovici & Hester F. Lingsma

  3. Department of Neurology, Erasmus MC Stroke Centre, Erasmus Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    Fop van Kooten

  4. Department of Neurology, Haaglanden Medical Centre, Postbus 432, 2501 CK, The Hague, The Netherlands

    Ishita P. Miah & Korné Jellema

  5. Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Wilco C. Peul & Niels A. van der Gaag

  6. Haaglanden MC and Haga Teaching Hospital, Postbus 432, 2501 CK, The Hague, The Netherlands

    Niels A. van der Gaag

  7. Department of Neurosurgery, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands

    Kuan H. Kho

  8. Department of Neurology, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Heleen M. den Hertog

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  1. Dana C. Holl
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Correspondence to Dana C. Holl.

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Dana C. Holl and Victor Volovici are shared first author

This article is part of the Topical Collection on Brain trauma

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Holl, D.C., Volovici, V., Dirven, C.M.F. et al. Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis. Acta Neurochir 161, 1231–1242 (2019). https://doi.org/10.1007/s00701-019-03881-w

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