Zhang Jianning
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, Tianjin, 300052, China.
Chin Neurosurg J. 2021 Nov 22;7(1):47. doi: 10.1186/s41016-021-00263-z.
Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between arachnoid and dura mater, which is usually formed in the third week after traumatic brain injury. Surgical treatment is usually the first choice for patients with CSDH having a significant space-occupying effect. Most of the patients showed good results of surgical treatment, but still some patients had a postoperative recurrence (the recurrence rate was up to 33%). Because CSDH is often seen in the elderly, patients are weak and have many basic diseases. The risk of surgical treatment is high; serious complications and even death (the death rate is up to 32%) can often occur. The overall good prognosis rate of patients aged more than 90 years is 24%. The drug treatment can provide a safe and effective treatment for elderly patients who are weak, intolerable to surgery, or failed in surgery. Low-dose and long-term use of atorvastatin (20mg/d) is suggested for continuous treatment for at least 8 weeks, while low-dose and short-term use of dexamethasone can improve the therapeutic effect of atorvastatin on CSDH. Patients should undergo CT or MRI scanning at least one time within 2 weeks after the start of drug treatment.
慢性硬膜下血肿（CSDH）是一种由蛛网膜和硬脑膜之间血液积聚形成的慢性占位性病变，通常在创伤性脑损伤后第三周形成。对于具有明显占位效应的CSDH患者，手术治疗通常是首选。大多数患者手术治疗效果良好，但仍有一些患者术后复发（复发率高达33%）。由于CSDH常见于老年人，患者身体虚弱且有多种基础疾病。手术治疗风险高；常可发生严重并发症甚至死亡（死亡率高达32%）。90岁以上患者的总体良好预后率为24%。药物治疗可为身体虚弱、无法耐受手术或手术失败的老年患者提供安全有效的治疗。建议低剂量长期使用阿托伐他汀（20mg/d）持续治疗至少8周，而低剂量短期使用地塞米松可提高阿托伐他汀对CSDH的治疗效果。患者应在药物治疗开始后2周内至少进行一次CT或MRI扫描。
