PhD defence D.C. (Dana) Holl

Dissertation in short:

Since CSDH is a common disease with growing incidence, lacking a clear definition and consensus on optimal treatment we defined the following aims for the research described in this thesis. 

-    To characterize CSDH through time (Part I).
-    To describe the current management of CSDH, specifically the role of corticosteroid therapy (Part II).
-    To evaluate the effectiveness of corticosteroids compared to surgery (Part II and III). 
-    To improve future CSDH research and treatment (Part III).

The work in this thesis gives insight into the historical descriptions of chronic subdural hematoma (CSDH) and its pathophysiology. We evaluated which treatments are currently used and preferred by treating physicians in the management of CSDH. The main focus of this thesis was to evaluate the effect of corticosteroids in CSDH treatment. The current evidence suggests that corticosteroids should not be used as stand-alone treatment. Furthermore, there is no high-level evidence to use dexamethasone as additional treatment in the standard care of CSDH patients. Burr hole craniostomy is the preferred treatment option in patients with neurological deficits.

With an (inter)national collaborative approach and a large scale prospective registry we will be able to develop more insight and  share ideas on new high quality trials. The development of a core outcome set, a standardized CSDH definition and data elements to be used in future studies on this common but complex condition will be mandatory.