Certaines thrapeutiques sont associes au geste chirurgical dans le but damliorer les suites opratoires dans le traitement de lhmatome sous-dural chronique (HSDC). Daprs lenqute de la Socit franaise de neurochirurgie publie en 2001, 38% des neurochirurgiens franais utilisent une corticothrapie en association leur geste chirurgical.

Existe-t-il une efficacit de cette corticothrapie sur les suites opratoires des HSDC?

Une tude rtrospective a t ralise dans le service de neurochirurgie du CHU de Nice, sur les cas oprs entre janvier 1998 et juillet 2002. La corticothrapie tait institue immdiatement aprs lintervention et maintenue pendant un mois. Une partie des patients na pas t traite par corticothrapie, ce qui permit la comparaison des deux groupes.

Cent quatre-vingt-dix-huit patients ont pu tre inclus dans ltude. Cent quarante-deux patients appartenaient au groupe corticothrapie et 56 patients au groupe pas de corticothrapie. La diffrence sur la survie entre les deux groupes tait significative en faveur du groupe sous corticothrapie y compris aprs analyse multivarie.

Il a pu tre mis en vidence un effet protecteur de la corticothrapie postopratoire sur la survie des patients. Cet effet persistait aprs analyse multivarie. Cependant, il sagissait dune approche rtrospective avec les biais que cela comporte. Afin de confirmer ces rsultats, une tude multicentrique prospective randomise est en cours dinstitution.

Adjuvant treatments can be proposed in addition to surgery for patients with chronic subdural hematoma (CSDH) in order to improve the postoperative outcome. According to the survey published in 2001 by the Neurosurgery French Society, 38% of French neurosurgeons use adjuvant corticosteroid therapy after surgery.

Does this adjuvant corticosteroid therapy have an effect on the postoperative outcome of CSDH?

A retrospective trial was performed on patients who were surgically treated for CSDH between January 1998 and July 2002 in the Nice Department of Neurosurgery.

Corticosteroid therapy was initiated just after surgery and maintained for one month. Part of the patients were not given corticosteroids enabling a comparison of two groups: corticosteroid therapy versus no corticosteroid therapy.

One hundred and ninety-eight patients were included in the trial, 142 patients in the corticosteroid therapy group and 56 patients in the no corticosteroid therapy group. The difference in survival between the two groups was significant in favor of the group give corticosteroids. A multivariate analysis was carried out which confirmed the beneficial effect of the corticosteroid therapy on survival of the operated patients. Their risk of death was threefold less than those not given this treatment (p = 0.006).

This study highlighted a protective effect of postoperative corticosteroid therapy on patient survival. This effect persisted at multivariate analysis. However, due to skews inherent in retrospective studies, a multicentric prospective randomized trial is being prepared in our institution to confirm these results.