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Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment, and Outcome
James Feghali1, Wuyang Yang1, Judy Huang1
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Chronic subdural hematoma (CSDH) affects many elderly individuals annually. Research explores new drug therapies and embolization techniques to improve CSDH treatment and reduce recurrence rates.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Chronic subdural hematoma (CSDH) is a significant neurological condition with an incidence of 1.7-20.6 per 100,000 person-years, predominantly affecting the elderly.
- The pathophysiology involves complex inflammatory and traumatic cycles, leading to the formation of vascularized membranes that promote hematoma expansion.
Purpose of the Study:
- To review current and emerging therapeutic strategies for managing chronic subdural hematoma.
- To highlight advancements in both pharmacological and interventional treatments for CSDH.
Main Methods:
- Review of existing literature on CSDH pathophysiology, incidence, and treatment modalities.
- Analysis of current clinical trials investigating novel drug targets and endovascular techniques.
Main Results:
- Burr hole craniostomy remains the primary surgical intervention with generally good outcomes.
- Recurrence rates of 10%-20% are linked to specific clinical and radiographic factors.
- Middle meningeal artery embolization is an emerging endovascular treatment under active clinical evaluation.
Conclusions:
- CSDH management is evolving with ongoing research into pharmacological agents targeting its complex pathophysiology.
- Minimally invasive techniques like middle meningeal artery embolization offer new therapeutic avenues.
- Further clinical trials are crucial to establish the efficacy and role of these novel treatments in reducing CSDH recurrence.
Abstract:
Chronic subdural hematoma (CSDH) is a complex disease with an overall incidence of 1.7-20.6 per 100,000 persons per year and is more commonly encountered in the elderly population. The pathophysiologic cycle of CSDH formation and expansion involves traumatic and inflammatory components that promote the formation of membranes with permeable neovessels. Many drugs targeting different elements of this cycle are being actively investigated as potential therapeutic agents in CSDH. Burr hole craniostomy appears to be the most commonly used procedure for surgical evacuation, and outcomes are generally favorable. Recurrence can occur in 10%-20% of patients and is associated with several clinical and radiographic predictors. Middle meningeal artery embolization represents one of the latest additions to the therapeutic arsenal of cerebrovascular specialists in treating CSDH and is being critically evaluated in numerous ongoing clinical trials.
