Breda, The Netherlands—With an aging population and the widespread use of anticoagulant medications, the common disorder chronic subdural hematoma has been increasing in prevalence.

A study in the New England Journal of Medicine pointed out that minor head trauma often precedes the development of the hematoma, but it also can occur without trauma. The condition is thought to occur because of an inflammatory response in the subdural space.

“Surgical evacuation of the hematoma by means of burr-hole craniotomy, often combined with placement of a subdural or subperiosteal drain, is the mainstay of treatment in symptomatic patients,” the Dutch authors wrote. “Albeit effective, surgical drainage carries a risk of death, and up to 10% of patients have recurrence of the subdural collection of fluid.”

More recently, glucocorticoid therapy has been proposed as an alternative, nonoperative treatment for chronic subdural hematoma. “Dexamethasone has the potential to block inflammatory changes in the subdural space, thereby impeding hematoma persistence and growth, and is administered to patients for this purpose in some institutions,” the study advised.

The study team conducted a multicenter, open-label, controlled, noninferiority trial in The Netherlands, randomly assigning symptomatic patients with chronic subdural hematoma in a 1:1 ratio to a 19-day tapering course of dexamethasone or to burr-hole drainage.

The results were disappointing, indicating that dexamethasone treatment “was not noninferior to burr-hole drainage with respect to functional outcomes and was associated with more complications and a greater likelihood of later surgery.”

The researchers recruited 252 patients of a planned sample size of 420 from September 2016 through February 2021; 127 were assigned to the dexamethasone group and 125 to the surgery group. The mean age of the patients was 74 years, and 77% were men.

“The trial was terminated early by the data and safety monitoring board owing to safety and outcome concerns in the dexamethasone group,” the authors reported. The study team reported that 55% of the patients in the dexamethasone group eventually underwent surgery, as compared with 6% of those in the surgery group who underwent reoperation.

“More patients in the dexamethasone group than in the surgery group died, and patients in the dexamethasone group had more complications and longer hospital stays than those in the surgery group,” according to the report.

Other recent trials also suggested that dexamethasone therapy for chronic subdural hematoma resulted in worse outcomes than placebo; however, some uncontrolled studies had shown beneficial effects of dexamethasone for chronic subdural hematoma.

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