Chronic subdural hematoma: A common pathology with complex management

Lizana J.; Aliaga N.; Basurco A. · Surgical Neurology International (2021) · DOI: 10.25259/sni_676_2021

Resumen

Background: Chronic subdural hematoma (CSDH) is a widely studied, very common pathology, especially in elderly; its clinical symptoms have a benign appearance, but it is usually accompanied by multiple comorbidities associated with age, resulting in severe complications and even death. With the increase in life expectancy worldwide, the use of antithrombotic drugs is also increasingly frequent. Its role in the progression of the disease as in its recurrence, continues to be a reason for discussion Methods: The authors review the pathophysiology and clinical features of the CSDH. The paper discusses current and new therapeutical options that potentially could improve the results. This manuscript is susceptible for changes through time, as technology and science become more advanced. Results: CSDH can be addressed with both pharmacological and surgical treatments; nevertheless, management of individual patients requires careful consideration of a number of factors. Despite the advances in neurosurgery, classical cranial trepanation continues to be the gold standard treatment in CSDH and especially in patients with severe symptoms. It should be noted that there are aspects of this procedure (such as the location of the drain, number of drains, the irrigation effect, and the temperature of the solution with which it is irrigated) that are still in study. Conclusion: Understanding the mechanism of the disease has allowed us to explain its natural history and propose new therapeutic modalities. Medical treatment (atorvastatin, corticosteroids) has generated great interest due to its encouraging preliminary results. Recently, endovascular management has been published as an efficient and safe alternative; there are great expectations to confirm its effect in larger studies.