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Drug treatment of chronic subdural hematoma
Jinhao Huang1,2, Chuang Gao1,2, Jingfei Dong3
1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Insights
Chronic subdural hematoma (CSDH) treatment is challenging due to poor understanding of its causes. This review explores drug therapies for CSDH, highlighting the need for more clinical trials to find effective non-surgical options.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Pharmacology
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with increasing incidence, particularly in aging populations.
- While often linked to head trauma, the precise mechanisms underlying CSDH remain unclear.
- Current primary treatment involves surgery, which is not suitable for all patients and carries a risk of recurrence, necessitating alternative therapeutic strategies.
Purpose of the Study:
- To review the pathogenesis of chronic subdural hematoma (CSDH).
- To examine existing and potential pharmacological treatments for CSDH, including monotherapy and adjuvant roles.
- To assess the evidence from clinical trials for non-surgical CSDH interventions.
Main Methods:
- Literature review of CSDH pathogenesis.
- Analysis of drug therapies investigated for CSDH treatment.
- Evaluation of controlled clinical trials and their limitations.
Main Results:
- The pathophysiology of CSDH is not fully elucidated, complicating the development of targeted drug therapies.
- Existing drug treatments for CSDH have primarily been assessed in small studies with limited controls.
- Evidence for the efficacy of non-surgical treatments, including drug monotherapy or as adjuncts to surgery, is currently insufficient.
Conclusions:
- Further research into CSDH pathophysiology is crucial for identifying effective drug targets.
- Larger, well-controlled clinical trials are essential to validate the efficacy and safety of drugs for non-surgical CSDH management.
- Developing non-surgical treatments is a high priority given surgical limitations and recurrence rates in CSDH.
Abstract:
Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, whose incidence has been steadily increasing with our aging population. While not common, CSDH can also occur in children. CSDH is often associated with traumatic head injury, but its underlying mechanism remains poorly understood. The first line treatment for CSDH is surgery. However, surgery is contraindicated in some patients and has a high rate of recurrence. Effective non-surgical treatment is therefore highly desirable.Areas covered: This review discusses the pathogenesis of CSDH and drugs that have been used to treat CSDH either as monotherapy or an adjuvant to surgery, including controlled clinical trials.Expert opinion: The pathophysiology of CSDH remains poorly understood. Developing effective drug treatments is therefore challenging. Most drugs discussed in this review are evaluated in small clinical studies without sufficient sample size and controls for confounding variables. More controlled clinical trials are therefore needed to carefully evaluate drugs for the non-surgical treatment of CSDH, especially for drugs targeting specific pathogenic pathways of CSDH.
