Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review

Abstract

This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.

Effects of atorvastatin on chronic subdural hematoma

“…[3–5] Previous studies have reported that corticosteroids, angiotensin converting enzyme inhibitors, tranexamic acid may be adjunctive to surgery, or even as a monotherapy for CSDH treatment. [2,6,7] Nonetheless, there are various surgical intervention and drug options for patients with CSDH, achieving a clinically efficient permanent cure is still far out of reach, and no explicit mechanism can explain this situation so far, we have known that high- and mixed-density of hematoma, leukemia, chronic renal failure, liver diseases are the risk factors for CSDH recurrence. [8] …”

“…The angiotensin-converting enzyme inhibitors have been found to inhibit the development of immature and new blood vessels in the neomembrane of hematoma. [7] Although previous studies have reported that corticosteroids and tranexamic acid may be beneficial, the evidences remain inadequate. [1,9–11] Recently, atorvastatin has been reported to be effective to CSDH treatment.…”

Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma

“…Few studies have reported on the prognosis of CSDH patients with or without frailty. Furthermore, most of the previous studies on CSDH focused on surgical method and recurrence reduction, and did not investigate the prognosis of CSDH . Previous studies have shown that age, presence of dementia and the severity of neurological symptoms on admission are correlated with the prognosis of CSDH patients .…”

“…Furthermore, most of the previous studies on CSDH focused on surgical method and recurrence reduction, and did not investigate the prognosis of CSDH. [13][14][15] Previous studies have shown that age, presence of dementia and the severity of neurological symptoms on admission are correlated with the prognosis of CSDH patients. [1][2][3][4] The present study showed that frailty was associated with poor prognosis.…”

Subdural hematoma cases identified through a Danish patient register: diagnosis validity, clinical characteristics, and preadmission antithrombotic drug use

“…aSDH is often the result of severe acute trauma, while for patients with cSDH the trauma, if present, has usually occurred several days to weeks prior to manifestation and is often relatively modest. 2 Advanced age and other factors leading to reduced brain volume, for example, alcohol overuse, increase an individual's risk of cSDH. Use of antithrombotic drugs, mainly vitamin K antagonists (VKAs), has also been associated with increased risk of cSDH.…”