ROLE OF STEROIDS IN PREVENTION OF RECURRENCE OF CHRONIC SUBDURAL HEMATOMA OPERATED CASES: A PROSPECTIVE STUDY
Main Article Content
Keywords
Chronic subdural hematoma; dexamethasone; steroid therapy; burr-hole surgery; recurrence prevention; neurological outcome; anti-inflammatory therapy; neurosurgical intervention; hematoma resolution; clinical outcomes.
Abstract
Background
Chronic subdural hematoma (CSDH) represents a significant neurosurgical challenge, particularly in the elderly population. Despite surgical intervention being the primary treatment modality, recurrence rates remain concerning, ranging from 5-30%. This study investigated the efficacy of postoperative steroid administration in preventing CSDH recurrence and improving neurological outcomes.
Methods
A prospective randomized controlled study was conducted between November 2023 and October 2024, involving 84 patients who underwent burr-hole surgery for CSDH. Patients were equally randomized into either the steroid group (n=42) receiving postoperative dexamethasone or the control group (n=42). The study evaluated recurrence rates, neurological outcomes using the modified Rankin Scale (mRS), radiological resolution and complications over a 6-month follow-up period.
Results
The steroid group demonstrated significantly lower recurrence rates (7.1% vs 19.0%, p=0.04) and better neurological improvement (mean mRS improvement 1.8 ± 0.6 vs 1.4 ± 0.7, p=0.03) compared to the control group. Radiological resolution was superior in the steroid group (92.9% vs 76.2%, p=0.02) with shorter hospital stays (4.2 ± 1.8 vs 5.1 ± 2.1 days, p=0.04). While the steroid group showed a trend toward more minor complications, none reached statistical significance in severity or frequency.
Conclusion
Postoperative steroid administration effectively reduces CSDH recurrence rates and enhances neurological recovery following burr-hole surgery. The therapeutic benefits appear to outweigh potential risks when appropriate patient selection and monitoring protocols are followed.
References
[2] Madzar M, Wiesmann M, Prömmel P, Shotar E, Stoffel M, Dabir D, et al. Clinical factors associated with recurrence of chronic subdural hematoma: A prospective study of 1023 patients. J Neurosurg 2023;138(1):276-85.
[3] Cofano F, Pesce A, Vercelli G, Mammi M, Massara A, Minardi M, et al. Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study. Front. Neurol 2020;11:560269.
[4] Emich S, Richling B, McCoy MR, Al-Schameri RA, Ling F, Sun L, et al. The efficacy of dexamethasone on reduction in the reoperation rate of chronic subdural hematoma–the DRESH study: straightforward study protocol for a randomized controlled trial. Trials. 2014;15:1-10.
[5] Haseeb A, Shafique MA, Raqib MA, Mughal ZU, Nasir R, Ali SM, et al. Efficacy and safety of steroids for chronic subdural hematoma: A systematic review and meta-analysis. Surgical Neurology International 2023;14.
[6] Hutchinson PJ, Edlmann E, Bulters D, Zolnourian A, Holton P, Suttner N, et al. Trial of dexamethasone for chronic subdural hematoma. New England Journal of Medicine 2020;383(27):2616-27.
[7] Shrestha DB, Budhathoki P, Sedhai YR, Jain S, Karki P, Jha P, et al. Steroid in chronic subdural hematoma: an updated systematic review and meta-analysis post DEX-CSDH trial. World Neurosurgery 2022;158:84-99.
[8] Yu W, Chen W, Jiang Y, Ma M, Zhang W, Zhang X, et al. Effectiveness comparisons of drug therapy on chronic subdural hematoma recurrence: a Bayesian network meta-analysis and systematic review. Front Pharmacol 2022;13:845386.
[9] Mebberson K, Colditz M, Marshman LAG, Thomas PAW, Mitchell PS, Robertson K. Prospective randomized placebo-controlled double-blind clinical study of adjuvant dexamethasone with surgery for chronic subdural haematoma with post-operative subdural drainage: Interim analysis. J Clin Neurosci 2020;71:153-7.
[10] Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: Inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 2017;16(1):93.
[11] Kolias AG, Edlmann E, Thelin EP, Bulters D, Holton P, Suttner N, et al. Dexamethasone for adult patients with a symptomatic chronic subdural haematoma (Dex-CSDH) trial: study protocol for a randomised controlled trial. Trials 2018;19:1-4.
[12] Mikkelsen R, Møller C, Thelin EP, Nordström CH, Lindén A, Tseng MY, et al. Chronic subdural hematoma: A single-center experience of surgical treatment and recurrence analysis. Acta Neurochir (Wien) 2023;165(3):871-9.
[13] Chen K, Wang K, Chen D, Niu H, Yang S, Wang Y. Surgical procedure in the treatment of organized chronic subdural hematoma: a single-center experience. Journal of Neurological Surgery Part A: Central European Neurosurgery 2021;82(03):241-7.
[14] Hong JC, Kim CH, Kim YJ, Kim CY, Chung CK, Park SH. Safety profile of postoperative steroid administration in chronic subdural hematoma: A multicenter study of 1,256 cases. World Neurosurg 2023;169:e156-64.
[15] Chan DY, Sun TF, Poon WS. Steroid for chronic subdural hematoma? A prospective phase IIB pilot randomized controlled trial on the use of dexamethasone with surgical drainage for the reduction of recurrence with reoperation. Chinese Neurosurgical Journal 2015;1:1-5.
[16] Zhang J. Expert consensus on drug treatment of chronic subdural hematoma. Chinese Neurosurgical Journal 2021 22;7(1):47.
[17] Holl DC, Volovici V, Dirven CM, van Kooten F, Miah IP, Jellema K, et al. Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis. Acta Neurochirurgica 2019;161:1231-42.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Jayant Jain
Assistant Professor, Department of Neurosurgery, NIMS Medical College, Jaipur, Rajasthan, India.
Dr. Oshin Chauhan
Senior Resident, Department of Neurosurgery, NIMS Medical College, Jaipur, Rajasthan, India.
Dr. Sanjeev Attry
Professor, Department of Neurosurgery, NIMS Medical College, Jaipur, Rajasthan, India.
Dr. Nishtha Vashisth
Assistant Professor, Department of Obstetrics & Gynaecology, NIMS Medical College, Jaipur, Rajasthan, India.