Use of dexamethasone in patients with chronic subdural hematoma: a systematic review
DOI:
https://doi.org/10.31157/an.v1iInpress.642Keywords:
Dexamethasone, Hematoma, Subdural, Chronic, dexametasona , cronicoAbstract
Introduction: Chronic subdural hematoma (CSCH) is an old collection of blood and blood degradation products in the subdural space that usually occurs in old age, predominantly affecting males. Surgical treatment is the treatment of choice in symptomatic patients, with conventional craniotomy being the most used, although it brings with it multiple complications. For this reason, in recent years the search for alternative therapies has increased, highlighting the interest in the use of glucocorticoids, especially dexamethasone (DXM), as a perioperative adjuvant or as monotherapy in HSC as it is considered an anti-inflammatory with anti-angiogenic effects and capable of inhibiting the formation of new blood vessels. The main objective of this work is to describe the efficiency, efficacy, and safety of the use of dexamethasone in patients older than 18 years with chronic subdural hematoma in comparison with surgical drainage or placebo group. Methods: The present systematic review was conducted according to PRISMA 2020 guidelines. Advanced searches were conducted between June and July 2023, in English and Spanish language, in the NEJM, PubMed and Embase databases through Cochrane Library using the descriptors and Boolean operators as follows: "Dexamethasone" AND "Hematoma, Subdural, Chronic", and custom year range 2018 - 2023. Results: 44 articles were found in the different databases, of which 12 were duplicates. Only 32 articles were reviewed for title and abstract reading. After applying the inclusion and exclusion criteria, only 10 articles were selected for a subsequent full-text review; five articles were finally included in the review. Discussion and conclusion: Apparently the use of DXM in patients with CSDH has a positive impact only on the risk of recurrence, however, no conclusive results were found. Likewise, the use of DXM in patients with CSDH is associated with an increased risk of complications and mortality, and no significant difference was demonstrated in functional outcomes and days of hospitalization compared to those who received primary surgery or placebo.
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