Thotakura Amit Kumar, Marabathina Nageswara Rao
Department of Neurosurgery, NRI Academy of Sciences, Guntur, Andhra Pradesh, India.
Asian J Neurosurg. 2018 Oct-Dec;13(4):976-983. doi: 10.4103/ajns.AJNS_13_17.
Surgery is the standard treatment for chronic subdural hematoma (CSDH), one of the common problems in neurosurgical practice. Although medical treatment was used by some authors and found some positive results, it is not accepted by many authors. The aim of this review is to give overall view of the medical management of CSDH. Action of various drugs in the pathophysiological cascade of formation of CSDH was depicted. The review of literature is done under three headings - the primary medical treatment of CSDH, adjuvant medical treatment with surgery, and the treatment of the recurrence. Various classifications of CSDH and the factors influencing the outcome of medical treatment are discussed. There is a role of medical treatment in a selected group of patients with CSDH. Well-designed, multicenter, randomized controlled trials are required to define the indications and standard protocols for the medical treatment of CSDH.
手术是慢性硬膜下血肿（CSDH）的标准治疗方法，CSDH是神经外科实践中常见的问题之一。尽管一些作者采用了药物治疗并取得了一些积极成果，但许多作者并不认可。本综述的目的是全面介绍CSDH的药物治疗。描述了各种药物在CSDH形成的病理生理级联反应中的作用。文献综述分为三个标题进行——CSDH的主要药物治疗、手术辅助药物治疗以及复发的治疗。讨论了CSDH的各种分类以及影响药物治疗结果的因素。药物治疗在特定的CSDH患者群体中具有一定作用。需要设计良好的多中心随机对照试验来确定CSDH药物治疗的适应症和标准方案。
