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Background <p>Chronic subdural hematoma (CSDH) is a common neurosurgical condition in older adults and is characterized by a high postoperative recurrence rate. The impact of systemic glucocorticoids administered perioperatively as an adjunct to surgical evacuation for CSDH remains uncertain.</p> Methods <p>We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to 30 September 2025 for randomized controlled trials comparing glucocorticoids with placebo as we included randomized controlled trials comparing perioperative systemic glucocorticoids versus placebo as an adjunct to surgery for CSDH. Eligible studies enrolled adult patients (≥ 18&#xa0;years) with radiologically confirmed CSDH. Relative risks (RRs) were calculated to assess clinical outcomes.</p> Results <p>Six randomized controlled trials involving a total of 1,374 patients were included. Compared with placebo, adjuvant perioperative glucocorticoid therapy significantly reduced the risk of postoperative recurrence of CSDH (RR = 0.39; 95% CI: 0.24–0.63; I<sup>2</sup> = 0%; <i>P</i> &lt; 0.01). Notably, glucocorticoid therapy was associated with a significantly higher incidence of psychiatric symptoms (RR = 2.94; 95% CI: 1.65–5.23; I<sup>2</sup> = 4%; <i>P</i> &lt; 0.01). However, glucocorticoid use did not increase the risk of postoperative infection (RR = 1.93; 95% CI: 0.75–4.96; I<sup>2</sup> = 59%; <i>P</i> = 0.17), and there was no significant difference in mortality between the two groups (RR = 1.59; 95% CI: 1.00–2.54; I<sup>2</sup> = 0%; <i>P</i> = 0.05).</p> Conclusions <p>Perioperative glucocorticoid therapy appears to reduce postoperative recurrence of chronic subdural hematoma. No clear increase in infection was observed, while the evidence for mortality remains imprecise and cannot exclude potential harm. However, glucocorticoids were associated with a higher risk of psychiatric symptoms compared with placebo. Clinicians should balance the benefit of reduced recurrence against the increased likelihood of psychiatric adverse events when considering glucocorticoids as adjuvant therapy in patients with CSDH.</p>

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Impact of perioperative glucocorticoids on postoperative recurrence and complications in chronic subdural hematoma: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2026年4月16日

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  • Yangbin Xia,
  • Xuchen Qi

摘要

Background

Chronic subdural hematoma (CSDH) is a common neurosurgical condition in older adults and is characterized by a high postoperative recurrence rate. The impact of systemic glucocorticoids administered perioperatively as an adjunct to surgical evacuation for CSDH remains uncertain.

Methods

We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to 30 September 2025 for randomized controlled trials comparing glucocorticoids with placebo as we included randomized controlled trials comparing perioperative systemic glucocorticoids versus placebo as an adjunct to surgery for CSDH. Eligible studies enrolled adult patients (≥ 18 years) with radiologically confirmed CSDH. Relative risks (RRs) were calculated to assess clinical outcomes.

Results

Six randomized controlled trials involving a total of 1,374 patients were included. Compared with placebo, adjuvant perioperative glucocorticoid therapy significantly reduced the risk of postoperative recurrence of CSDH (RR = 0.39; 95% CI: 0.24–0.63; I2 = 0%; P < 0.01). Notably, glucocorticoid therapy was associated with a significantly higher incidence of psychiatric symptoms (RR = 2.94; 95% CI: 1.65–5.23; I2 = 4%; P < 0.01). However, glucocorticoid use did not increase the risk of postoperative infection (RR = 1.93; 95% CI: 0.75–4.96; I2 = 59%; P = 0.17), and there was no significant difference in mortality between the two groups (RR = 1.59; 95% CI: 1.00–2.54; I2 = 0%; P = 0.05).

Conclusions

Perioperative glucocorticoid therapy appears to reduce postoperative recurrence of chronic subdural hematoma. No clear increase in infection was observed, while the evidence for mortality remains imprecise and cannot exclude potential harm. However, glucocorticoids were associated with a higher risk of psychiatric symptoms compared with placebo. Clinicians should balance the benefit of reduced recurrence against the increased likelihood of psychiatric adverse events when considering glucocorticoids as adjuvant therapy in patients with CSDH.