Abstract
Objectives:To compare the effect of burrhole craniostomy with and without a postoperative course of dexamethasone on recurrence rate of chronic subdural hematoma (CSDH).Methods:The study was conducted at the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad, from September 2017 till May 2018. Adult patients diagnosed with CSDH and advised burrhole craniostomy were enrolled in this prospective randomized controlled trial. Participants were randomized into Group-1 (receiving two weeks dexamethasone), and Group-2 (no dexamethasone). Clinical assessment and Brain CT were done preoperatively, second postoperative day, sixth and twelfth postoperative week, with outcome assessed at twelfth postoperative week. Complications of treatment and recurrence rate were recorded.Results:Ninety-two (n=92, 46 in each group) patients were enrolled. Improvement in neurological (95.7% vs 93.5%; P=0.646) and radiological outcome (95.7% vs 93.5%; P=0.646) was similar in both groups. Complication rate was higher in Group-1 but not significantly different (58.7% vs 43.5%; P=0.535). Most frequent complication was pneumocephalus, with mortality rate equal (n=one). Recurrence was observed in 2.2% (n=1/46) patients in Group-1 and 4.3% (n=2/46) in Group-2 (P=0.557), which was not statistically significant.Conclusions:Neurological and radiological outcome, and mortality rates were similar in both groups. The recurrence rate was lower and complications slightly higher in Group-1 but these were not statistically significant.
Highlights
Chronic subdural hematoma (CSDH) is a selfperpetuating inflammatory process of dura matter, wherein fluid collects within the dural border cell layer of the meninges
Adult patients of either gender diagnosed with CSDH and advised burrhole craniostomy were enrolled
Mean age (71.5 ± 13.3 years) and male-to-female ratio (3:1) of study subjects were similar to our study. They demonstrated preoperative corticosteroids resulted in lower recurrence rate and mortality risk in CSDH treated with burrhole craniostomy, with no increase in complication rates
Summary
Chronic subdural hematoma (CSDH) is a selfperpetuating inflammatory process of dura matter, wherein fluid collects within the dural border cell layer of the meninges. Brain atrophy causes stretching of subarachnoid and associated bridging veins making them susceptible to minor trauma, resulting in blood or cerebrospinal fluid leaking into the dural border cell layer causing local dissection.[1] A membrane forms around this collection, wherein inflammatory cells are recruited and activated, becoming a source of angiogenic and inflammatory factors.[2] A correlation exists between vascular-endothelial growth factor (VEGF) concentration within this. Pak J Med Sci November - December 2021 Vol 37 No 7 www.pjms.org.pk 1877 fluid and exudation rate from membrane vessels.[3] VEGF causes angiogenesis that undergoes recurrent micro-bleeding, resulting in increasing hematoma size. Higher ratios of inflammatory to anti-inflammatory mediators exist within the hematoma,[4] promoting angiogenesis, inflammation, hyper-permeability, and progression
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