Comparing the effectiveness of corticosteroid and surgery in managing chronic subdural hematoma: A systematic review and meta-analysis

Background: The optimal treatment for Chronic Subdural Hematoma (CSDH), corticosteroids or surgery, remains controversial. This meta-analysis compares the efficacy and safety of these interventions. Methods: We searched four databases until July 2023 for relevant studies. Data extraction was independently performed by two authors. Risk ratios (RR) with a 95% confidence interval (CI) were calculated for dichotomous outcomes and mean difference (MD) with a 95% CI for continuous outcomes.Results: Six studies involving 804 patients were included. Dexamethasone showed non-inferiority to surgery for good neurological outcomes (pooled RR = 1.02, 95% CI [0.95, 1.09], P = 0.60). No significant differences were found in mortality, recurrence rate, and hospital stay length between the two groups.Conclusion: Our analysis indicated that there was no statistically significant difference in terms of good neurological outcomes, length of hospital stay, mortality, and recurrence rate between the surgical interventions and dexamethasone. However, we noticed only clinical and numerical differences between the surgical interventions and dexamethasone regarding length of hospital stay, mortality, and recurrence rate. On the other hand, dexamethasone was associated with statistically higher complications compared to surgery. However, we should treat these results with caution as the only included RCT reported a high recurrence rate with dexamethasone indicating that surgery may be the first-line treatment for patients with CSDH.