The outcome after surgical vs nonsurgical treatment of chronic subdural hematoma with dexamethasone

Abstract

Background: To determine the patient outcomes of retrospectively collected data between surgical versus nonsurgical treatment of chronic subdural hematoma (CSDH) with Dexamethasone (DX). Methods: This was a retrospective study of 171 patients with chronic subdural hematoma between January 2012 and December 2016 and was derived into three groups: Group A: burr-hole craniostomy (BHC) with DX as an adjunct to surgery; Group B: BHC surgery without DX; and Group C: conservative treatment with DX monotherapy. Results: There were 120 males (70.1%) with mean age 76.4 ± 9.3 years (range 63 years, 33–96). In Group A [n = 24 (14.0%)], there were 20 males (80%) and the mean age was 75.5 ± 8.6 years. In Group B [n = 136 (80.1%)], there were 92 males (67.6%) with mean age 76.9 ± 11.3 years and in Group C [n = 10 (5.8%)], there were 8 males (80%) with mean age 70.0 ± 10.6 years.The incidence of recurrence in Group A was 1 case (4%) compared with Group B 10 cases (7.3%), and Group C 3 cases (30%) and there were a statistical significant difference between groups (P = 0.030). Conclusion: Patients with CSDHs have better outcome when treated with BHC and corticosteroids among other therapeutic options. Between BHC with DX and BHC without use of corticosteroids in surgical management of CSDHs, the combination therapy should be considered a first-choice. Keywords: Chronic subdural hematoma, Single burr hole, Corticosteroids monotherapy