Yun Ho Jun, Ding Yuchuan
Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
Brain Circ. 2020 Dec 29;6(4):254-259. doi: 10.4103/bc.bc_73_20. eCollection 2020 Oct-Dec.
Chronic subdural hematoma (CSDH) is one of the most prevalent neurosurgical disorders. Patients with CSDH commonly present with altered mental status, focal neurological deficit, and/or headache. The first-line treatment for CSDH is surgical evacuation. Although the surgical procedures for CSDH have been considered relatively "straightforward," they are not without any risk. The elderly are especially prone to show poor surgical outcomes. To make matters worse, many elderly patients are on anticoagulants and antiplatelet agents, increasing the risk of re-bleeding before and after surgery. These complications have led clinicians to search for nonsurgical alternatives. Dexamethasone should be used with caution for selected patients given its side effects. Tranexamic acid may be utilized as an adjunct therapy to surgery, but more randomized clinical trials are needed to evaluate its definitive efficacy. Interesting results of middle meningeal artery embolization (MMAE) have been reported from case studies. However, the risks associated with MMAE, including intracerebral hemorrhage, stroke, and vasospasm, have not been properly studied yet. The clinical benefits of atorvastatin and angiotensin-converting enzyme inhibitors are uncertain for CSDH. In conclusion, surgical intervention continues to be the first-line treatment while nonsurgical treatment options may be considered an adjunct therapy especially for recurrent hematoma or to reduce the volume of a hematoma.
慢性硬膜下血肿（CSDH）是最常见的神经外科疾病之一。CSDH患者通常表现为精神状态改变、局灶性神经功能缺损和/或头痛。CSDH的一线治疗方法是手术清除血肿。尽管CSDH的手术操作被认为相对“简单”，但并非没有任何风险。老年人尤其容易出现手术效果不佳的情况。更糟糕的是，许多老年患者正在服用抗凝剂和抗血小板药物，这增加了手术前后再次出血的风险。这些并发症促使临床医生寻找非手术替代方法。地塞米松因其副作用，应谨慎用于特定患者。氨甲环酸可作为手术的辅助治疗，但需要更多随机临床试验来评估其确切疗效。病例研究报告了脑膜中动脉栓塞术（MMAE）的有趣结果。然而，与MMAE相关的风险，包括脑出血、中风和血管痉挛，尚未得到充分研究。阿托伐他汀和血管紧张素转换酶抑制剂对CSDH的临床益处尚不确定。总之，手术干预仍然是一线治疗方法，而非手术治疗方案可被视为辅助治疗，特别是对于复发性血肿或减少血肿体积。
