The condition in question is a so-called chronic subdural haematoma, CSDH. This is a condition that occurs mostly in older men. They have increasing complaints of headaches, gaitdisorders, neurological dysfunction and memory problems. These symptoms often occur several days to weeks after a head injury.
Surgery or medication?
Treatment consists of either surgery (burrhole drainage) or an anti-inflammatory medication (dexamethasone). Patients are treated by neurologists and neurosurgeons, depending on the type of treatment. There was no clarity or agreement on what is the best treatment option for CSDH. As a result, there are major international differences, but also within the Netherlands there is no unambiguous policy. In the UMCG, patients undergo surgery in (almost) all cases, but in some other Dutch hospitals patients (almost) always receive treatment with the anti-inflammatory drug. Both treatment options have advantages but certainly also disadvantages, such as the risk surrounding surgery and the side effects of the anti-inflammatory drug.
Better outcomes for patients after surgery
To gain certainty about the best treatment for this vulnerable patient group, a large Dutch study was set up with funding from ZonMW, in which neurologists and neurosurgeons from a total of 12 hospitals collaborated. In this, patients were treated either with burrhole drainage or with the anti-inflammatory dexamethasone and followed intensively. The results of the study show that patients who received surgery fared much better than those treated with dexamethasone. Patients who received dexamethasone tended to spend longer in hospital and were twice as likely to have side effects, such as high blood sugar levels, inflammation or delirium. Also, half of the patients who were first treated with dexamethasone still needed additional surgery.
Surgery makes for better recovery
The study therefore concludes that dexamethasone should no longer be used in patients with CSDH. Indeed, surgery, despite the risks involved, gives a better chance of good recovery and outcome.
The results of the study were published in the leading international journal New England Journal of Medicine
From the UMCG, this multicentre study involved Prof Dr R.J.M Groen (neurosurgeon), Prof Dr J van der Naalt and Dr B. Jacobs (neurologists), and Dr J. Blaauw as PhD student.
The participating hospitals in the Netherlands: Admiraal de Ruyter Hospital, Albert Schweitzer Hospital, Erasmus MC, University Medical Centre Groningen, Haaglanden MC, HagaZiekenhuis, Isala Hospital, Leiden University Medical Centre, Maasstad Hospital, Medisch Spectrum Twente, Franciscus Gasthuis & Vlietland, Van Weel Bethesda Hospital.
