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Review
. 2021 Dec 8:15:786513.
doi: 10.3389/fnins.2021.786513. eCollection 2021.

Adjuvant Corticosteroids With Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

Min Shi  1 , Ling-Fei Xiao  2 , Ting-Bao Zhang  1 , Qing-Wen Tang  1 , Wen-Yuan Zhao  1
Affiliations
Review

Adjuvant Corticosteroids With Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

Min Shi et al. Front Neurosci. .

Abstract

The use of adjuvant corticosteroids with surgery for chronic subdural hematoma (CSDH) has received considerable attention in recent years. However, there is no conclusive evidence regarding its effectiveness and safety for CSDH. Therefore, we performed a meta-analysis and systematic review to evaluate the effectiveness and safety of corticosteroids as an adjuvant treatment for the treatment of CSDH. We comprehensively searched electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) to identify relevant trials that investigated the efficacy and safety of adjuvant corticosteroids with surgery for CSDH, published from inception until May 2021. Outcome measures included recurrence rate, all-cause mortality, good functional outcome, length of hospitalization, and adverse events. We used the Cochrane risk of bias method to evaluate the quality of randomized controlled trials (RCTs), and the Newcastle Ottawa Scale to evaluate the quality of observational studies. We included nine studies, consisting of three RCTs and six observational studies, that compared corticosteroids as an adjuvant treatment to surgery with surgery alone. Pooled results revealed that the risk of recurrence was significantly reduced in patients who received adjuvant corticosteroids with surgery compared to those who underwent surgery alone (relative risk [RR] = 0.52, 95% confidence interval [CI] = 0.39-0.69, p < 0.00001). However, no statistically significant difference was observed between these groups in all-cause mortality (RR = 0.91, 95% CI = 0.37-2.23, p = 0.83), good functional outcome (RR = 1.03, 95% CI = 0.96-1.10, p = 0.47), length of hospitalization (MD = 0.35, 95% CI = -2.23 to 1.67, p = 0.83), and infection rates (RR = 0.99, 95% CI = 0.64-1.53, p = 0.95). Adjuvant corticosteroids with surgery reduce the risk of recurrence of CDSH, but do not improve the all-cause mortality or functional outcome, as compared to surgery alone. These findings support the use of adjuvant corticosteroids with surgery for CSDH patients. Further high-quality RCTs are required to confirm the efficacy and safety of adjuvant corticosteroids in the treatment of CSDH patients.

Keywords: adjuvant treatment; chronic subdural hematoma; corticosteroids; mortality; poor outcome; recurrence.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the study selection process.
FIGURE 2
FIGURE 2
Meta-analysis of adjuvant corticosteroid group compared to the surgery alone group on recurrence rate.
FIGURE 3
FIGURE 3
Meta-analysis of adjuvant corticosteroid group compared to the surgery alone group on all-cause mortality.
FIGURE 4
FIGURE 4
Meta-analysis of adjuvant corticosteroid group compared to the surgery alone group on good functional outcome.
FIGURE 5
FIGURE 5
Meta-analysis of adjuvant corticosteroid group compared to the surgery alone group on length of hospitalization.
FIGURE 6
FIGURE 6
Meta-analysis of adjuvant corticosteroid group compared to the surgery alone group on infections.
FIGURE 7
FIGURE 7
Funnel plot of publication bias of recurrence rate.
See this image and copyright information in PMC

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