Department of Neurosurgery, Kawasaki Medical School.
Neurol Med Chir (Tokyo). 2023 Jan 15;63(1):1-8. doi: 10.2176/jns-nmc.2022-0207. Epub 2022 Oct 25.
In this paper, I review the historical changes in the etiological concepts and surgical treatments for chronic subdural hematoma (CSDH) across the world and in Japan. I also examine future problems associated with its surgical procedures and medical costs. CSDH was first reported by Wepfer in 1657 as "delayed apoplexy." In 1857, Virchow described the famous concept of so-called "pachymeningitis hemorrhagica interna." He considered that the etiology of CSDH involved inflammation. In 1914, Trotter described the origin of CSDH as traumatic. Currently, CSDH is considered to arise with a first leak of blood from dural border cells after mild trauma. Inflammatory cells are then drawn to the border cell layer. At this point, new membranes form from activated inflammation; then, the hematoma enlarges, promoted by angiogenic factors and new capillaries. In 1883, Hulke reported successful trepanning of a patient with CSDH. Burr holes and craniotomy for removal of the hematoma were subsequently reported, and new methods were developed over the course of several decades around the world. In Japan, after the first report by Nakada in 1938, many Japanese pioneering figures of neurological surgery have studied CSDH. After Mandai reported the middle meningeal artery embolization in 2000, this method is now considered useful as an initial or second treatment for CSDH. However, the age of patients is increasing, so more minimally invasive surgeries and useful pharmacotherapies are needed. We must also consider the costs for treating CSDH, because of the increasing numbers of surgical cases.
本文综述了慢性硬脑膜下血肿（CSDH）在世界和日本的病因概念和手术治疗的历史变化，并探讨了其手术程序和医疗费用相关的未来问题。CSDH 于 1657 年由 Wepfer 首次报道为“迟发性中风”。1857 年，Virchow 描述了所谓的“内硬脑膜出血性脑脊髓膜炎”的著名概念。他认为 CSDH 的病因涉及炎症。1914 年，Trotter 将 CSDH 的起源描述为创伤性的。目前，CSDH 被认为是在轻度创伤后，从硬脑膜边缘细胞首次漏出血液后发生的。然后，炎症细胞被吸引到边缘细胞层。此时，激活的炎症会形成新的膜；然后，在血管生成因子和新毛细血管的作用下，血肿增大。1883 年，Hulke 报道了一例 CSDH 患者成功颅骨切开术的病例。随后报道了颅骨钻孔和血肿切除术，在过去几十年中，世界各地都开发了新的方法。1938 年，Nakada 首次报道日本病例后，日本神经外科学的许多先驱人物都对 CSDH 进行了研究。2000 年 Mandai 报道了脑膜中动脉栓塞后，该方法现在被认为是 CSDH 的初始或二次治疗的有效方法。然而，患者的年龄在增加，因此需要更多的微创手术和有效的药物治疗。我们还必须考虑到治疗 CSDH 的成本，因为手术病例数量不断增加。
