Mgt of Chronic Subdural Hematoma Using Dexamethasone
Status:
Unknown status
Trial end date:
2021-09-01
Target enrollment:
Participant gender:
Summary
Chronic subdural hematoma (cSDH) is a collection of blood and its breakdown products in the
subdural compartment. It is a condition frequently seen in any neurosurgical practice. cSDH
is believed to arise from tearing of bridging veins as a result of trauma, which may be minor
and unapparent to the patient. Management of cSDH is widely varied. A "wait-and-see" or
"wait-and-rescan" approach may be acceptable in asymptomatic patients with a relatively small
hematoma whilst cSDH with severe neurological deficits or decreased level of consciousness
may require surgical decompression by burr-hole craniostomy, twist drill craniostomy or
craniotomy. Surgery is associated with serious morbidity and mortality of up to 17% and
recurrence rates of 4%-33% requiring further treatment in some instances.The safety and
efficacy of different neurosurgical procedures have been evaluated but there is a paucity of
well-designed randomized controlled trials in the literature. Consequently, there is no
consensus on the best treatment with respect to surgical technique, pre-operative and
post-operative management and nonsurgical alternatives including the use of Corticosteroids,
Tranexamic acid, Osmotic diuretics, Atorvastatin or Angiotensin converting enzyme (ACE)
inhibitors.
Corticosteroids may be a therapeutic option in the management of cSDH. There is very little
data on the efficacy of corticosteroids in the treatment of cSDH and certainly no randomized
trials. The purpose of the study is to prove dexamethasone can be just as efficacious as
surgery in treating chronic subdural hematoma. The investigators also hope to show that those
patients treated with dexamethasone suffer less complication compared to those who undergo
surgery.