Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis

被引:43
作者
Holl, Dana C. [1 ,2 ]
Volovici, Victor [1 ,2 ,3 ]
Dirven, Clemens M. F. [1 ,2 ]
van Kooten, Fop [4 ]
Miah, Ishita P. [5 ]
Jellema, Korne [5 ]
Peul, Wilco C. [6 ]
van der Gaag, Niels A. [6 ,7 ,8 ]
Kho, Kuan H. [9 ]
den Hertog, Heleen M. [10 ]
Dammers, Ruben [1 ,2 ]
Lingsma, Hester F. [3 ]
机构
[1] Erasmus MC, Erasmus MC Stroke Ctr, Dept Neurosurg, NL-3000 CA Rotterdam, Netherlands
[2] Dr Molewaterpl 40, NL-3015 GD Rotterdam, Netherlands
[3] Erasmus MC, Dept Publ Hlth & Med Decis Making, Dr Molewaterpl 40, NL-3015 GD Rotterdam, Netherlands
[4] Erasmus MC, Erasmus MC Stroke Ctr, Dept Neurol, Dr Molewaterpl 40, NL-3015 GD Rotterdam, Netherlands
[5] Haaglanden Med Ctr, Dept Neurol, Postbus 432, NL-2501 CK The Hague, Netherlands
[6] Leiden Univ, Med Ctr, Dept Neurosurg, Albinusdreef 2, NL-2333 ZA Leiden, Netherlands
[7] Haaglanden MC, Postbus 432, NL-2501 CK The Hague, Netherlands
[8] Haga Teaching Hosp, Postbus 432, NL-2501 CK The Hague, Netherlands
[9] Med Spectrum Twente, Dept Neurosurg, Koningspl 1, NL-7512 KZ Enschede, Netherlands
[10] Isala Hosp Zwolle, Dept Neurol, Dokter van Heesweg 2, NL-8025 AB Zwolle, Netherlands
关键词
Burr hole; Chronic subdural hematoma; Corticosteroids; Medical management; Nonsurgical treatment; SURGICAL-TREATMENT; RISK-FACTORS; INDEPENDENT PREDICTORS; UNITED-STATES; MANAGEMENT; DEXAMETHASONE; RECURRENCE; DRAINAGE; THERAPY;
D O I
10.1007/s00701-019-03881-w
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BackgroundThere 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.MethodA 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).ResultsOf 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.ConclusionsThis 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.
引用
收藏
页码:1231 / 1242
页数:12
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