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Steroids have been hypothesized to promote resolution of chronic subdural hematomas (cSDH), although a recent multicenter, randomized, controlled trial demonstrated that they are associated with increased complications and worse neurologic outcomes. Since nearly all patients in the dexamethasone arm of that study also received surgical hematoma evacuation, the current trial was designed to determine if therapy with dexamethasone alone would improve outcomes compared with surgical management. Patients with cSDH severity ranging from Markwalder Grade Scale 1 (headache only) to 3 (severe focal neurologic deficits) were randomized, 125 to burr-hole evacuation and 127 to a 19-day dexamethasone taper starting at 8 mg twice daily.
The trial was sto…