KISA ETKİLİ KORTİZON ,UZUN ETKİ

Öz

Amaç: Kronik subdural hematom (cSDH), özellikle yaşlı insanlar arasında yaygın olan yaygın ve genelliklede semptom olmadan bir nörolojik hastalıktır. Çalışmamızdaki amaç cSDH olan hastalarda monoterapi olarak hidrokortizonun etkinliğini değerlendirmek. Materyal ve Metod: Kliniğimizde 18 yaş üzerinde olan beyin bilgisayarlı tomografisinde (CT) yeni teşhis edilen semptomatik cSDH tespit edilen hastalar nörolojik sonucu 0'dan 4'e kadar ölçen Markwalder Grading Scale göre değerlendirildi. Monoterapi olarak oral 100 mg hidrokortizon ile tedaviye başlandı. Cerrrahide cSDH üzerine tek burr hole craniostomy yapıldı. Sonuç: 102 hasta çalışmaya alındı. Bunlardan 47'si hidrokortizon grubuna ve 55'i cerrahi grubuna atandı. Hastaların 59'u erkek ve ortalama yaş 66.8 olarak saptandı. Cerrahi grupta, cerrahi sonrası 55 hastanın 52'inde olumlu bir sonuç gözlemlendi. Cerrahi grubundaki 55 hastanın 3'üne cSDH için tekrar cerrahi uygulandı. Hidrokortizon grubunda 3. ayda 47 hastanın 38'inde (%80.9) olumlu bir sonuç saptandı. Hidrokortizon grubunda 7 hastada, cerrahi grubunda 2 hastada özel ilgi uyandıran advers olaylar meydana geldi. Tartışma cSDH hidrokortizon monoterapisi minimal yan etkiler ile klinik iyileşmede etkili olduğu görülmektedir..

Anahtar Kelimeler

• HİDROKORTİZONE
• KRONİK
• subdural
• kanama

Short Hydrocortisone Long Effect

Öz

ABSTRACT Background: Chronic subdural hematoma (cSDH) is a common neurological condition, particularly among the elderly, often presenting asymptomatically. This study aims to evaluate the efficacy of hydrocortisone as a monotherapy in patients with cSDH. Methods: In our clinic, patients over 18 years of age with newly diagnosed symptomatic cSDH detected by brain computed tomography (CT) were evaluated according to the Markwalder Grading Scale, which measures neurological outcomes from 0 to 4. Treatment was started with oral 100 mg hydrocortisone as monotherapy. A single burr hole craniotomy (BHC) was performed on the cSDH in the surgery. Results: A total of 102 patients were included in the study, with 47 assigned to the hydrocortisone group and 55 to the surgery group. The mean patient age was 66.8 years, with 58% being male. In the surgical group, 94.5% of patients exhibited favorable outcomes postoperatively, with 6.5% requiring reoperation. In the hydrocortisone group, 80.9% demonstrated clinical improvement at three months, while 19.2% required surgical intervention. Adverse events were observed in 14.9% of the hydrocortisone group and 3.6% of the surgical group. The average hospital stay was significantly shorter in the hydrocortisone group (2.9 vs. 6.8 days, p < 0.05). Conclusion: Hydrocortisone monotherapy shows potential as a viable treatment for select cSDH patients, particularly those with mild to moderate symptoms. Further prospective studies are needed to validate its long-term efficacy and safety. Keywords: hydrocortisone, chronic subdural hematoma, burr hole craniostomy, corticosteroids

Anahtar Kelimeler

• hydrocortisone
• subdural
• hematoma

Kaynakça

1. Albadrani MS, Almutairi SG, Aljeelani YO, Farsi SH, Alahmadi MH, Aljohani MA, et al. Comparing the Effectiveness of Corticosteroid and Surgery in Managing Chronic Subdural Hematoma: A Systematic Review and Meta-analysis. Interdiscip Neurosurg. 2023;34:101842. Crossref
2. Bartley A, Bartek J Jr, Jakola AS, Sundblom J, Fält M, Förander P, et al; Tisell M. Effect of irrigation fluid temperature on recurrence in the evacuation of chronic subdural hematoma: a randomized clinical trial. JAMA Neurol. 2023;80(1):58-63. Crossref
3. Kameyama M, Kawase M, Hirano T, Matsuyo K, Tominaga T. Epidemiology of chronic subdural hematomas. No Shinkei Geka. 2011;39(12):1149-1153.
4. Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am. 2017;28(2):205-210. Crossref
5. Shapey J, Glancz LJ, Brennan PM. Chronic subdural haematoma in the elderly: is it time for a new paradigm in management? Curr Geriatr Rep. 2016;5(2):71-77. Crossref
6. Srivatsan A, Mohanty A, Nascimento FA, Hafeez MU, Srinivasan VM, Thomas A, et al. Middle meningeal artery embolization for chronic subdural hematoma: meta-analysis and systematic review. World Neurosurg. 2019;122:613-619. Crossref
7. Sezer C, Gokten M, Acıkalın R. Troponin I new biomarker in traumatic brain injury. Indian J Surg. 2023;85(1):120-126. Crossref
8. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010;113(3):615-621. Crossref

9. Peters DR, Parish J, Monk S, Pfortmiller D, Henegar M, Bernard J, et al. Surgical treatment for a chronic subdural hematoma in the elderly: a retrospective analysis. World Neurosurg X. 2023;18:100183. Crossref
10. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155-169. Crossref
11. Feghali J, Yang W, Huang J. Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg. 2020;141:339-345. Crossref
12. Ivamoto HS, Lemos HP Jr, Atallah AN. Surgical treatments for chronic subdural hematomas: a comprehensive systematic review. World Neurosurg. 2016;86:399-418. Crossref
13. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc. 2008;43(1):11-15. Crossref
14. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009;374(9695):1067-1073. Crossref
15. Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22(Suppl 3):67-79. Crossref
16. Di Rienzo A, Iacoangeli M, Alvaro L, Colasanti R, Somma LGMD, Nocchi N, et al. Mini-craniotomy under local anesthesia to treat acute subdural hematoma in deteriorating elderly patients. J Neurol Surg A Cent Eur Neurosurg. 2017;78(6):535-540. Crossref
17. Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017;14(1):108. Crossref
18. Holl DC, Volovici V, Dirven CMF, Peul WC, van Kooten F, Jellema K, et al. Pathophysiology and nonsurgical treatment of chronic subdural hematoma: from past to present to future. World Neurosurg. 2018;116:e402-e411. Crossref
19. Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg. 2016;11(4):330-342. Crossref
20. Guo S, Gao W, Cheng W, Liang C, Wu A. Endoscope-assisted surgery Vs burr-hole craniostomy for the treatment of chronic subdural hematoma: a systemic review and meta-analysis. Front Neurol. 2020;11:540911. Crossref
21. Hutchinson PJ, Edlmann E, Bulters D, Zolnourian A, Holton P, Suttner N, et al. Trial of dexamethasone for chronic subdural hematoma. N Engl J Med. 2020;383(27):2616-2627. Crossref
22. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg. 1981;55(3):390-396. Crossref
23. Liu W, Bakker NA, Groen RJM. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014;121(3):665-673. Crossref
24. Almenawer SA, Farrokhyar F, Hong C, et al. Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg. 2014;259(3):449-457. Crossref
25. Di Rienzo A, Iacoangeli M, Alvaro L, Colasanti R, Somma LGMD, Nocchi N, et al. Mini-craniotomy under local anesthesia to treat acute subdural hematoma in deteriorating elderly patients. J Neurol Surg A Cent Eur Neurosurg. 2017;78(6):535-540. Crossref
26. Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22(Suppl 3):67-79. Crossref
27. Holl DC, Volovici V, Dirven CMF, van Kooten F, Miah IP, Jellema K, et al. Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis. Acta Neurochir (Wien). 2019;161(6):1231-1242. Crossref
28. Edlmann E, Holl DC, Lingsma HF, et al. Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach. Acta Neurochir (Wien). 2020;162(4):763-776. Crossref
29. Hutchinson PJ, Edlmann E, Bulters D, Zolnourian A, Holton P, Suttner N, et al. Trial of dexamethasone for chronic subdural hematoma. N Engl J Med. 2020;383(27):2616-2627. Crossref
30. Miah IP, Holl DC, Blaauw J, Lingsma HF, den Hertog HM, Jacobs B, et al. Dexamethasone versus Surgery for Chronic Subdural Hematoma. N Engl J Med. 2023;388(24):2230-2240. Crossref
31. Fountas K, Kotlia P, Panagiotopoulos V, Fotakopoulos G. The outcome after surgical vs nonsurgical treatment of chronic subdural hematoma with dexamethasone. Interdiscip Neurosurg. 2019;16:70-74. Crossref
32. Yagnik KJ, Goyal A, Van Gompel JJ. Twist drill craniostomy vs burr hole drainage of chronic subdural hematoma: a systematic review and meta-analysis. Acta Neurochir (Wien). 2021;163(12):3229-3241. Crossref
33. Uno M. Chronic subdural hematoma - Evolution of etiology and Surgical Treatment. Neurol Med Chir (Tokyo). 2023;63(1):1-8. Crossref
34. Sun TF, Boet R, Poon WS. Non-surgical primary treatment of chronic subdural haematoma: Preliminary results of using dexamethasone. Br J Neurosurg. 2005;19(4):327-333. Crossref
35. Qian Z, Yang D, Sun F, Sun Z. Risk factors for recurrence of chronic subdural hematoma after burr hole surgery: potential protective role of dexamethasone. Br J Neurosurg. 2017;31(1):84-88. Crossref
36. Delgado-López PD, Martín-Velasco V, Castilla-Díez JM, Rodríguez-Salazar A, Galacho-Harriero AM, Fernández-Arconada O. Dexamethasone treatment in chronic subdural haematoma. Neurocirugia (Astur). 2009;20(4):346-359. Crossref