Medical management of chronic subdural hematoma with low-dose hydrocortisone: a case series

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Tarih

2024

Dergi Başlığı

Dergi ISSN

Cilt Başlığı

Yayıncı

Springer Science and Business Media Deutschland GmbH

Erişim Hakkı

info:eu-repo/semantics/closedAccess

Özet

Chronic subdural hematomas (cSDH) are often managed with a burr-hole craniostomy and drainage, but surgery is associated with elevated mortality, morbidity, and recurrence. Despite reports of steroid use for such patients, its efficacy and feasibility are still debated. We present our patient series treated with low-dose hydrocortisone. We retrospectively reviewed data from patients treated with hydrocortisone between 2017 and 2023. Demographics, clinical and radiological data were collected. Of 27 patients identified, nine required a burr-hole craniotomy for an average volume of 120.23 cm3, average midline shift of 9 mm, and neurological deficits. Eighteen met the criteria for inclusion. The mean age was 78.5 years; 13 were male. None had severe symptoms requiring urgent intervention. Except for one with a Karnofsky Performance Scale score of 70, all could maintain normal activity before treatment. The mean baseline volume was 52.6 cm3. Midline shift, present in six, averaged 6.8 mm. Patients underwent treatment for an average of 5.15 months. Nine had complete resolution within 3 months, while nine required longer treatment, including one who needed 9 months for a re-bleed after a fall. Paired t-tests indicated significant reductions in hematoma volumes at the second week (p = 0.01), first month (p < 0.0001), and third month (p < 0.0001) of treatment. No complications occurred and the post-treatment Karnofsky scores ranged from 90 to 100. Treatment for cSDH should be tailored to the patient. Low-dose hydrocortisone is safe and effective in asymptomatic patients, those with mild to moderate symptoms, and those who are either unsuitable for or decline surgical intervention. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.

Açıklama

Anahtar Kelimeler

Chronic, Glucocorticoids, Hematoma, Hydrocortisone, Subdural

Kaynak

Neurosurgical Review

WoS Q Değeri

Q1

Scopus Q Değeri

Q1

Cilt

47

Sayı

1

Künye

Gurses, M. E., Ulgen, M., Gökalp, E., Gecici, N. N., Gungor, A., Türe, H., & Türe, U. (2024). Medical management of chronic subdural hematoma with low-dose hydrocortisone: a case series. Neurosurgical review, 47(1), 509.