Chronic subdural hematoma (CSDH) is a common neurological disease. The prevalence rises rapidly due to increasing age and widespread use of anticoagulants.
Burr hole craniostomy is the current standard practice. However, in several hospitals dexamethasone is used as a non-surgical alternative. Efficacy of dexamethasone has yet to be proven in high quality comparison studies.
Randomized controlled trials are necessary to evaluate the effect of dexamethasone therapy compared to surgery on functional outcome and cost-effectiveness.
We hypothesize that treatment with dexamethasone is as effective as BHC, at lower costs.
Effect of dexamethasone therapy versus surgery in CSDH patients on
A prospective, multicenter, randomized controlled trial
- Presence of a CSDH
- Severity of symptoms must be MGS 1-3
- Symptoms must correlate to the cerebral lesion
- Patient would be an eligible candidate for BHC (i.e. hematoma thickness ≥10mm)
- ≥18 years
- MGS 0 or MGS 4
- Acute subdural hematoma
- Minimal CSDH which is technically not drainable (i.e. hematoma thickness < 10 mm)
- Cerebrospinal fluid shunt in situ
- Known hypersensitivity to dexamethasone
- Known ulceration in the gastro-intestinal tract or history of gastro-intestinal bleeding
- Uncontrolled diabetes mellitus (DM), defined as a HbA1C value > 8% (64 mmol/mol)
- Clinical suspicion of a systemic infection (fever, leukocytosis, elevated C-reactive protein (CRP))
- Previous history of severe affective disorders on steroids (i.e. psychosis)
Patients are randomized to either initial treatment with dexamethasone or burr hole craniostomy.
Dexamethasone tapering course:
Day 1 - 4 2 x 8 mg
Day 5 -7 2 x 4 mg
Day 8 -10 2 x 2 mg
Day 11 -13 2 x 1 mg
Day 14 -16 2 x 0.5 mg
Day 17 -19 1 x 0.5 mg
Day 20 stop
With the addition of pantoprazol 1 x 40 mg on day 1 - 20.
If the response to dexamethasone is insufficient, surgery will be performed.