Scerrati Alba, Visani Jacopo, Ricciardi Luca, Dones Flavia, Rustemi Oriela, Cavallo Michele Alessandro, De Bonis Pasquale
1Department of Morphology, Anatomy and Experimental Medicine, University of Ferrara.
2Department of Neurosurgery, Sant'Anna University Hospital, Ferrara.
Neurosurg Focus. 2020 Oct;49(4):E7. doi: 10.3171/2020.7.FOCUS20237.
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.
The authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were "chronic subdural hematoma," "conservative treatment/management," "pharmacological treatment," "non-surgical," "tranexamic acid," "dexamethasone," "corticosteroid," "glucocorticoid," "middle meningeal artery," "endovascular treatment," and "embolization."
The authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.
The results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable.
慢性硬膜下血肿（CSDH）是最常见的神经外科疾病之一，通常影响老年人。随着人口老龄化，其发病率预计会上升。手术引流是首选治疗方法；然而，术后并发症和复发率不可忽视。因此，非手术替代方法（如脑膜中动脉栓塞、类固醇或氨甲环酸给药）在全球范围内越来越受欢迎，需要仔细评估，尤其是在老年人群中。
作者根据PRISMA标准对分析CSDH非手术策略的研究进行了系统评价。他们通过搜索不同的医学数据库收集了1990年至2019年期间发表的所有英文论文。所选关键词为“慢性硬膜下血肿”、“保守治疗/管理”、“药物治疗”、“非手术”、“氨甲环酸”、“地塞米松”、“皮质类固醇”、“糖皮质激素”、“脑膜中动脉”、“血管内治疗”和“栓塞”。
作者最终收集了15篇符合标准的关于CSDH药物治疗的文章，14篇论文包括血管内治疗。
结果表明，对于有症状的大CSDH患者，手术仍然是主要治疗方法；然而，辅助和替代疗法在精心挑选的人群中可能有效且安全。建议将它们纳入新的指南。
