Dexamethasone therapy in symptomatic chronic subdural hematoma: A retrospective evaluation of initial corticosteroid therapy versus primary surgery (DECSA - R).

Abstract

Worldwide different strategies are being applied for symptomatic chronic subdural hematoma (CSDH). Aim of this study was to evaluate the efficacy of two treatment strategies for symptomatic CSDH: initial dexamethasone (DXM) therapy versus primary surgery by burr hole craniostomy (BHC). We retrospectively collected data of 120 symptomatic CSDH patients in two neurotrauma centers between 2014 and 2016, each with their own treatment protocol. Sixty patients received primary BHC (center A), and another 60 initial DXM therapy (center B). Primary outcome was evaluated by dichotomized modified Rankin Scale (mRS) score (0-3 and 4-6) and MGS score at three months. Secondary outcomes were additional interventions, CSDH recurrence, mortality, complications and duration of hospital stay. Baseline characteristics were similar in both groups. At three months a favorable mRS score (0-3) was observed in 70% and 76% in cohort A and B respectively (OR 0.77, 95% CI 0.30-1.98, p=0.59). A favorable MGS score (0-1) was observed in 96% in both groups (OR 0.98, 95% CI 0.45-2.15, p=0.95). CSDH recurrence was 12% in cohort A and 22% in cohort B (p=0.15). Mortality was 10% in both cohorts. In cohort B additional surgery was performed in 83% at a median of six days and significantly more patients had complications (55% vs 35%, p=0.02), a prolonged hospitalization (10 vs. 5 days; p=0.02) and one or more follow-up cranial CT s (85% vs. 48%; p<0.001). To achieve a favorable clinical outcome, initial DXM therapy was associated with a high rate of cross-over to surgery, significantly longer overall hospital stay and more complications compared to primary surgery. Chronic subdural hematoma, CSDH, corticosteroid therapy, dexamethasone, burr hole craniostomy.