The use of dexamethasone therapy for conservative management of chronic subdural hematomas: a question about efficacy and safety

Chronic subdural hematoma (CSDH) is a commonly encountered neurosurgical entity, particularly among the elderly population. Surgical intervention by trepanation or burr hole craniostomy remains the gold standard approach for symptomatic cases. However, despite the excellent outcome, the surgical pathway remains also associated with possible complications, some of which might be fatal, in addition to a recurrence rate of up to 25%. Dexamethasone (DXM) therapy was used as an alternative non-surgical approach, yet its clinical effectiveness remains controversial. Therefore, the objective of this study is to evaluate the outcome of DXM use for the management of chronic subdural hematomas with regard to the clinical results, safety, efficacy and potential incidence of complications.

This is a retrospective study of 30 patients, with symptomatic CSDH managed by the authors by DXM therapy protocol. Subjects were assessed upon admission then closely monitored to evaluate their response to conservative management, then followed up and their data were recorded at 2 weeks, 1 month, 3 months, and 6 months after protocol initiation. Clinical scoring systems included the Glasgow Coma Scale (GCS) and the Markwalder Grading Scale (MGS), whereas radiological evaluation consisted of serial Computerized tomography (CT)scans to assess CSDH changes between time of protocol initiation and over the same time intervals. There was a statistically highly significant improvement regarding the GCS and the MGS of the studied cases on comparing the starting values to those throughout the follow-up intervals at 2 weeks, 1 month, 3 months, or six months (p = 0.001). Patients presented with a neurological deficit also showed a statistically highly significant improvement on comparing the values at the beginning of our study to those recorded at the third month or those at the sixth month (p = 0.001).

Our study concluded that dexamethasone use is a safe and effective choice for the management of chronic subdural hematoma with an acceptable success rate and a low incidence rate of serious complications. We do not advocate for the replacement of surgery by DXM treatment but to consider its possible role in selected cases. Larger series and further studies would be yet considered with longer follow-up periods.