# Effects of adjuvant low-dose dexamethasone on recurrence in patients with significant residual chronic subdural hematoma after burr-hole drainage: a single-institution retrospective case-control series

## TL;DR

Low-dose dexamethasone after surgery for chronic subdural hematoma significantly reduced recurrence in patients with large residual collections.

## Contribution

Demonstrates that adjuvant low-dose dexamethasone reduces recurrence in high-risk CSDH patients after burr-hole drainage.

## Key findings

- Dexamethasone reduced recurrence from 22.9% to 3.4% in patients with >50% residual hematoma.
- The three-week regimen was well-tolerated with only one mild adverse event reported.
- Findings suggest selective corticosteroid use in high-risk CSDH cases.

## Abstract

Recurrence after surgical treatment remains a significant challenge in the management of chronic subdural hematoma (CSDH). Patients with large postoperative residual collections are at increased risk, and adjuvant dexamethasone treatment appears promising as it may reduce inflammation within residual collections.

This study evaluates the effectiveness of adjuvant low-dose dexamethasone treatment in reducing recurrence rates in patients with significant residual hematomas (>50 %) after burr-hole drainage.

A retrospective case-control study was conducted on CSDH patients treated at the Military Medical Academy, Belgrade, from 2016 to 2023. Patients undergoing burr-hole craniostomy with postoperative residual CSDH collection >50 % of the preoperative volume were included. A subset received adjuvant low-dose dexamethasone (initial 2 mg twice daily, tapering over three weeks) decided arbitrarily by the treating neurosurgeon. Primary outcome was recurrence.

A total of 99 patients met the inclusion criteria, with a mean age of 74.1 years. Recurrence was observed in 16 of 70 patients (22.9 %) in the control compared to only 1 of 29 (3.4 %) in the dexamethasone group (OR = 0.12, p = 0.045). The protective effect remained pronounced in the multivariate model, and only a single mild dexamethasone adverse event was observed.

Adjuvant low-dose dexamethasone significantly reduced recurrence rates in CSDH patients with large postoperative residual collections. These findings suggest that low-dose corticosteroid therapy may be a viable adjunct to surgical treatment, but only in cases at increased risk of recurrence. However, further prospective trials are necessary to confirm these results and establish standardized guidelines.

•Adjuvant low-dose dexamethasone treatment significantly reduced recurrence rate of chronic subdural hematoma (from 22.9 % to 3.4 %) in patients with >50 % residual collection after burr-hole drainage.•The three-week low-dose regimen (initial 4 mg/day, tapered weekly) was well-tolerated with only one reported mild adverse effect (sleep disturbance).•Findings support selective postoperative corticosteroid use in high-risk chronic subdural hematoma cases, warranting further prospective validation.

Adjuvant low-dose dexamethasone treatment significantly reduced recurrence rate of chronic subdural hematoma (from 22.9 % to 3.4 %) in patients with >50 % residual collection after burr-hole drainage.

The three-week low-dose regimen (initial 4 mg/day, tapered weekly) was well-tolerated with only one reported mild adverse effect (sleep disturbance).

Findings support selective postoperative corticosteroid use in high-risk chronic subdural hematoma cases, warranting further prospective validation.