Efficacy of the Non-Surgical Treatment of Chronic Subdural Hematoma: A Systematic Review

Abstract

Background Chronic subdural hematoma (CSDH) is one of the most common neurological diseases. Surgical treatment is the gold standard treatment. However, the hematoma recurs in up to 25% of cases. In addition, many complications may occur after surgery. Despite the fact that conservative treatment for CSDH has grown in popularity, no medicine currently has level 1 evidence to back it up.

Objective To figure out the efficacy of the non-surgical treatment of CSDH and to highlight its role in mildly symptomatic or asymptomatic patients.

Patients and Methods The following electronic databases were searched for studies from 2000 to 2020: PubMed, Google Scholar, EMBASE, and Science Direct, using appropriate combinations of the following Keywords: chronic subdural hematoma, hemorrhage, CSDH, bleeding, non-surgical treatment, conservative management or treatment, alternative management or treatment, dexamethasone, steroids, corticosteroid, pharmacological treatment.

Results Fifteen studies met our selection criteria. A total of 616 patients received medical treatment for CSDH. Their mean age was 70.49 years, including 468 males (76%) and 148 females (24%). Improvement of the presenting symptoms occurred in 477 patients (77.44%), and 139 patients (22.56%) required surgical intervention.

Conclusion The results of the previous studies suggested that medical treatment in selected patients was a valid option as a primary treatment and as an adjuvant therapy with surgical evacuation for CSDH. Further randomized controlled studies with larger patient cohorts are needed to determine the true value of each drug in the conservative treatment of CSDH.