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

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...

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Bibliographic Details
Published in:Neurosurgical review 2024-08, Vol.47 (1), p.509, Article 509
Main Authors: Gurses, Muhammet Enes, Ulgen, Meric, Gökalp, Elif, Gecici, Neslihan Nisa, Gungor, Abuzer, Türe, Hatice, Türe, Uğur
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anti-Inflammatory Agents - administration & dosage
Anti-Inflammatory Agents - therapeutic use
Craniotomy
Female
Hematoma, Subdural, Chronic - drug therapy
Hematoma, Subdural, Chronic - surgery
Humans
Hydrocortisone - administration & dosage
Hydrocortisone - therapeutic use
Male
Medicine
Medicine & Public Health
Middle Aged
Neurosurgery
Retrospective Studies
Treatment Outcome
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Summary: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 cm 3 , 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 cm 3 . 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  
ISSN:1437-2320
1437-2320
DOI:10.1007/s10143-024-02763-9