TY - JOUR
T1 - Corticosteroid treatment compared with surgery in chronic subdural hematoma
T2 - a systematic review and meta-analysis
AU - Holl, Dana C.
AU - Volovici, Victor
AU - Dirven, Clemens M.F.
AU - van Kooten, Fop
AU - Miah, Ishita P.
AU - Jellema, Korné
AU - Peul, Wilco C.
AU - van der Gaag, Niels A.
AU - Kho, Kuan H.
AU - den Hertog, Heleen M.
AU - Dammers, Ruben
AU - Lingsma, Hester F.
N1 - Funding Information:
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.
Publisher Copyright:
© 2019, Springer-Verlag GmbH Austria, part of Springer Nature.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
KW - Burr hole
KW - Chronic subdural hematoma
KW - Corticosteroids
KW - Medical management
KW - Nonsurgical treatment
UR - http://www.scopus.com/inward/record.url?scp=85065918049&partnerID=8YFLogxK
U2 - 10.1007/s00701-019-03881-w
DO - 10.1007/s00701-019-03881-w
M3 - Review article
C2 - 30972566
AN - SCOPUS:85065918049
SN - 0001-6268
VL - 161
SP - 1231
EP - 1242
JO - Acta neurochirurgica
JF - Acta neurochirurgica
IS - 6
ER -