Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series
Objective: Recurrence after surgical treatment remains a significant challenge in the management of chronic subdural hematoma (CSDH). Patients with large postoperative residual collections are at increased risk, and adjuvant dexamethasone treatment appears promising as it may reduce inflammation wit...
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| Format: | Article |
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425001353 |
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| author | Aleksandar Bojović Milan Lepić Stefan Mandić-Rajčević Sanja Lepić Svetozar Stanković Aleksandar Djurdjević Aleksandra Lokaj Miloš Božić Nemanja Rančić |
| author_facet | Aleksandar Bojović Milan Lepić Stefan Mandić-Rajčević Sanja Lepić Svetozar Stanković Aleksandar Djurdjević Aleksandra Lokaj Miloš Božić Nemanja Rančić |
| author_sort | Aleksandar Bojović |
| collection | DOAJ |
| description | Objective: Recurrence after surgical treatment remains a significant challenge in the management of chronic subdural hematoma (CSDH). Patients with large postoperative residual collections are at increased risk, and adjuvant dexamethasone treatment appears promising as it may reduce inflammation within residual collections. Research question: This study evaluates the effectiveness of adjuvant low-dose dexamethasone treatment in reducing recurrence rates in patients with significant residual hematomas (>50 %) after burr-hole drainage. Methods: A retrospective case-control study was conducted on CSDH patients treated at the Military Medical Academy, Belgrade, from 2016 to 2023. Patients undergoing burr-hole craniostomy with postoperative residual CSDH collection >50 % of the preoperative volume were included. A subset received adjuvant low-dose dexamethasone (initial 2 mg twice daily, tapering over three weeks) decided arbitrarily by the treating neurosurgeon. Primary outcome was recurrence. Results: A total of 99 patients met the inclusion criteria, with a mean age of 74.1 years. Recurrence was observed in 16 of 70 patients (22.9 %) in the control compared to only 1 of 29 (3.4 %) in the dexamethasone group (OR = 0.12, p = 0.045). The protective effect remained pronounced in the multivariate model, and only a single mild dexamethasone adverse event was observed. Discussion and conclusion: Adjuvant low-dose dexamethasone significantly reduced recurrence rates in CSDH patients with large postoperative residual collections. These findings suggest that low-dose corticosteroid therapy may be a viable adjunct to surgical treatment, but only in cases at increased risk of recurrence. However, further prospective trials are necessary to confirm these results and establish standardized guidelines. |
| format | Article |
| id | doaj-art-06b9ca27407448d3a57c1aa96268d756 |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-06b9ca27407448d3a57c1aa96268d7562025-08-20T03:28:26ZengElsevierBrain and Spine2772-52942025-01-01510431610.1016/j.bas.2025.104316Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control seriesAleksandar Bojović0Milan Lepić1Stefan Mandić-Rajčević2Sanja Lepić3Svetozar Stanković4Aleksandar Djurdjević5Aleksandra Lokaj6Miloš Božić7Nemanja Rančić8Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, SerbiaMedical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia; Corresponding author. Clinic for Neurosurgery, Military Medical Academy, Crnotravska 17, 11000, Belgrade, Serbia.School of Public Health, Faculty of Medicine, University of Belgrade, Belgrade, SerbiaFaculty of Medicine, University of Belgrade, SerbiaMedical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Neurosurgery, Military Medical Academy, Belgrade, SerbiaMedical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Neurosurgery, Military Medical Academy, Belgrade, SerbiaMedical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Neurosurgery, Military Medical Academy, Belgrade, SerbiaMedical Faculty of the Military Medical Academy, University of Defence, Belgrade, SerbiaMedical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute of Radiology, Military Medical Academy, Belgrade, SerbiaObjective: Recurrence after surgical treatment remains a significant challenge in the management of chronic subdural hematoma (CSDH). Patients with large postoperative residual collections are at increased risk, and adjuvant dexamethasone treatment appears promising as it may reduce inflammation within residual collections. Research question: This study evaluates the effectiveness of adjuvant low-dose dexamethasone treatment in reducing recurrence rates in patients with significant residual hematomas (>50 %) after burr-hole drainage. Methods: A retrospective case-control study was conducted on CSDH patients treated at the Military Medical Academy, Belgrade, from 2016 to 2023. Patients undergoing burr-hole craniostomy with postoperative residual CSDH collection >50 % of the preoperative volume were included. A subset received adjuvant low-dose dexamethasone (initial 2 mg twice daily, tapering over three weeks) decided arbitrarily by the treating neurosurgeon. Primary outcome was recurrence. Results: A total of 99 patients met the inclusion criteria, with a mean age of 74.1 years. Recurrence was observed in 16 of 70 patients (22.9 %) in the control compared to only 1 of 29 (3.4 %) in the dexamethasone group (OR = 0.12, p = 0.045). The protective effect remained pronounced in the multivariate model, and only a single mild dexamethasone adverse event was observed. Discussion and conclusion: Adjuvant low-dose dexamethasone significantly reduced recurrence rates in CSDH patients with large postoperative residual collections. These findings suggest that low-dose corticosteroid therapy may be a viable adjunct to surgical treatment, but only in cases at increased risk of recurrence. However, further prospective trials are necessary to confirm these results and establish standardized guidelines.http://www.sciencedirect.com/science/article/pii/S2772529425001353Chronic subdural hematomaRecurrenceCorticosteroidsLow-dose dexamethasone |
| spellingShingle | Aleksandar Bojović Milan Lepić Stefan Mandić-Rajčević Sanja Lepić Svetozar Stanković Aleksandar Djurdjević Aleksandra Lokaj Miloš Božić Nemanja Rančić Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series Brain and Spine Chronic subdural hematoma Recurrence Corticosteroids Low-dose dexamethasone |
| title | Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series |
| title_full | Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series |
| title_fullStr | Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series |
| title_full_unstemmed | Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series |
| title_short | Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series |
| title_sort | effects of adjuvant low dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr hole drainage a single institution retrospective case control series |
| topic | Chronic subdural hematoma Recurrence Corticosteroids Low-dose dexamethasone |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425001353 |
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