Zhong Yao1, Xin Hu1, Lu Ma1, Chao You2. 1. Department of Neurosurgery, West China Hospital, Sichuan University and West China Brain Research Centre, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China. 2. Department of Neurosurgery, West China Hospital, Sichuan University and West China Brain Research Centre, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China. youchaohx@aliyun.com.
Abstract
BACKGROUND: Chronic subdural haematoma is a common but retractable neurological disease in the elderly with a high rate of recurrence. Dexamethasone (DX) either as monotherapy or adjuvant therapy has been applied clinically, but its effectiveness and feasibility remain controversial. We conducted this review to clarify this issue. METHODS: With a systematic review through multiple databases, we retrieved eligible English language publications and extracted relevant data to perform meta-analyses. The respective risk ratio (RR) and its 95% confidence interval (CI) were pooled to evaluate the overall effect. RESULTS: Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference on recurrence rate between DX alone and non-DX therapy or surgical therapy (RR, 0.86; 95% CI, 0.43-1.71; p = 0.66) (RR, 0.89; 95% CI, 0.43-1.85; p = 0.76). Comparison between DX alone with the surgical therapy demonstrated no difference on the poor outcome (RR, 0.40; 95% CI, 0.15-1.04; p = 0.06). CONCLUSIONS: We had no enough evidence to support DX use as an effective alternation to surgical therapy. But adjuvant DX use may facilitate the surgical therapy by reducing recurrence. Further study focusing on adjuvant DX was required.
BACKGROUND:Chronic subdural haematoma is a common but retractable neurological disease in the elderly with a high rate of recurrence. Dexamethasone (DX) either as monotherapy or adjuvant therapy has been applied clinically, but its effectiveness and feasibility remain controversial. We conducted this review to clarify this issue. METHODS: With a systematic review through multiple databases, we retrieved eligible English language publications and extracted relevant data to perform meta-analyses. The respective risk ratio (RR) and its 95% confidence interval (CI) were pooled to evaluate the overall effect. RESULTS: Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference on recurrence rate between DX alone and non-DX therapy or surgical therapy (RR, 0.86; 95% CI, 0.43-1.71; p = 0.66) (RR, 0.89; 95% CI, 0.43-1.85; p = 0.76). Comparison between DX alone with the surgical therapy demonstrated no difference on the poor outcome (RR, 0.40; 95% CI, 0.15-1.04; p = 0.06). CONCLUSIONS: We had no enough evidence to support DX use as an effective alternation to surgical therapy. But adjuvant DX use may facilitate the surgical therapy by reducing recurrence. Further study focusing on adjuvant DX was required.
Authors: Elena I Fomchenko; Emily J Gilmore; Charles C Matouk; Jason L Gerrard; Kevin N Sheth Journal: Curr Treat Options Neurol Date: 2018-06-23 Impact factor: 3.598
Authors: Rong Cai Jiang; Dong Wang; Shi Guang Zhao; Ren Zhi Wang; De Zhi Kang; Xin Gen Zhu; Zong Mao Zhao; Jun Ji Wei; Ying Huang; Yan Qu; Xiao Chuan Sun; Hong Ming Ji; Xiao Chun Jiang; Jin Fang Liu; Xi De Zhu; Jian Jun Wang; Ye Tian; Chuang Gao; Hui Jie Wei; Shu Zhang; Wei Quan; Shu Yuan Yue; Ping Lei; Xian Li; Li Li Song; Craig S Anderson; Jian Ning Zhang Journal: Trials Date: 2021-12-11 Impact factor: 2.279