| Autor: |
Miah IP; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), The Hague, The Netherlands.; Department of Neurology and Neurosurgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands., Herklots M; Department of Neurology, Elisabeth-TweeSteden Ziekenhuis (ETZ), Tilburg, The Netherlands., Roks G; Department of Neurology, Elisabeth-TweeSteden Ziekenhuis (ETZ), Tilburg, The Netherlands., Peul WC; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), The Hague, The Netherlands.; Department of Neurology and Neurosurgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.; Department of Neurology, Isala Hospital Zwolle, Zwolle, The Netherlands., Walchenbach R; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), The Hague, The Netherlands., Dammers R; Department of Neurosurgery, Erasmus Medical Center (EMC), Rotterdam, The Netherlands., Lingsma HF; Department of Public Health and Medical Decision Making, Erasmus Medical Center (EMC), Rotterdam, The Netherlands., den Hertog HM; Department of Neurology, Isala Hospital Zwolle, Zwolle, The Netherlands., Jellema K; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), The Hague, The Netherlands., Van der Gaag NA; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), The Hague, The Netherlands.; Department of Neurology and Neurosurgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.; Department of Neurology and Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands. |
| Abstrakt: |
Worldwide, different strategies are being applied for symptomatic chronic subdural hematoma (CSDH). The aim of this study was to evaluate the efficacy of two treatment strategies for symptomatic CSDH: initial dexamethasone (DXM) therapy versus primary surgery by burr hole craniostomy (BHC). We retrospectively collected data for 120 symptomatic CSDH patients in two neurotrauma centers between 2014 and 2016, each with their own treatment protocol. Sixty patients received primary BHC (center A), and another 60 initial DXM therapy (center B). Primary outcome was evaluated by dichotomized modified Rankin Scale (mRS) score (0-3 and 4-6) and Markwalder Grading Scale (MGS) score at 3 months. Secondary outcomes were additional interventions, CSDH recurrence, mortality, complications, and duration of hospital stay. Baseline characteristics were similar in both groups. At 3 months, a favorable mRS score (0-3) was observed in 70% and 76% of patients in cohort A and B, respectively (odds ratio [OR] 0.77, 95% CI 0.30-1.98; p = 0.59). A favorable MGS score (0-1) was observed in 96% of patients in both groups (OR 0.98, 95% CI 0.45-2.15; p = 0.95). CSDH recurrence was 12% in cohort A and 22% in cohort B ( p = 0.15). Mortality was 10% in both cohorts. In cohort B, additional surgery was performed in 83% at a median of 6 days, and significantly more patients had complications (55% vs. 35%, p = 0.02), a prolonged hospitalization (10 vs. 5 days; p = 0.02), and one or more follow-up cranial CT's (85% vs. 48%; p < 0.001). To achieve a favorable clinical outcome, initial DXM therapy was associated with a high rate of crossover to surgery, significantly longer overall hospital stay, and more complications compared with primary surgery. |
