Local application of corticosteroids combined with surgery for the treatment of chronic subdural hematoma

Xu, Xiaoping; Liu, Cong; Liu, Jian; Pang, Yuan-Guang; O, Xu-Dong Lu; Fu, Jun; Liang, Zhongxing; Fan, Yi

doi:10.5137/1019-5149.jtn.8989-13.3

Cited by 5 publications

(3 citation statements)

References 20 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Stanisic et al showed significantly higher levels of proinflammatory mediators (interleukin-2 receptor, and interleukins 5, 6 and 7) and anti-inflammatory mediators in the cSDH fluid compared with systemic levels, as well as a higher ratio of pro-to anti-inflammatory mediators [15]. The contact between cSDH fluid and the dural border cells seems to evoke a local aseptic inflammatory and inflammation-induced angiogenic reaction [16]. This angiogenic reaction leads to the formation of neomembranes that cause repeated microbleeds into the haematoma cavity.…”

Section: Introductionmentioning

confidence: 99%

The conservative and pharmacological management of chronic subdural haematoma: a systematic review

Soleman¹,

Nocera²,

Mariani³

2017

Swiss Med Wkly

View full text Add to dashboard Cite

Chronic subdural haematoma (cSDH), one of the most common neurosurgical entities, occurs typically in elderly patients. The incidence is expected to double by the year 2030, owing to the continuous aging of the population. Surgery is usually the treatment of choice, but conservative treatment may be a good alternative in some situations. We provide a systematic review of studies analysing the conservative treatment options and the natural history of cSDH. Of 231 articles screened, 35 were included in this systematic review. Studies evaluating the natural history and conservative treatment modalities of cSDH remain sparse and are predominantly of low level of evidence. The natural history of cSDH remains unclear and is analysed only in case reports or very small case series. “Wait and watch” or “wait and scan” management is indicated in patients with no or minor symptoms (Markwalder score 0–1). However, it seems that there are no clear clinical or radiological signs indicating whether the cSDH will resolve spontaneously or not (type C recommendation). In symptomatic patients who are not worsening or in a comatose state, oral steroid treatment might be an alternative to surgery (type C recommendation). Tranexamic acid proved effective in a small patient series (type C recommendation), but its risk of increasing thromboembolic events in patients treated with antithrombotic or anticoagulant medication is unclear. Angiotensin converting-enzyme inhibitors were evaluated only as adjuvant therapy to surgery, and their effect on the rate of recurrence remains debatable. Mannitol showed promising results in small retrospective series and might be a valid treatment modality (type C recommendation). However, the long treatment duration is a major drawback. Patients presenting without paresis can be treated with a platelet activating factor receptor antagonist (type C recommendation), since they seem to promote resolution of the haematoma, especially in patients with hygromas or low-density haematomas on computed tomography. Lastly, atorvastatin seems to be a safe option for the conservative treatment of asymptomatic or mildly symptomatic cSDH patients (type C recommendation). In conclusion, our knowledge of the conservative treatment modalities for cSDH is sparse and based on small case series and low grade evidence. However, some treatment modalities seem promising even in symptomatic patients with large haematomas. Randomised controlled trials are currently underway, and will hopefully provide us with good evidence for or against the conservative treatment of cSDH.

show abstract

Section: Introductionmentioning

confidence: 99%

The conservative and pharmacological management of chronic subdural haematoma: a systematic review

Soleman¹,

Nocera²,

Mariani³

2017

Swiss Med Wkly

View full text Add to dashboard Cite

show abstract

“…These results suggest that for some patients, steroids may be the only therapy required; however, there were complications from systemic corticosteroid use including hyperglycemia and gastritis 49 . Local, intrahematoma administration of steroids has been attempted by Xu et al 50 Twenty-six patients underwent hematoma evacuation and local application of methylprednisolone into the hematoma cavity. All patients were recurrence free, and none experienced complications related to the steroid treatment.…”

Section: Discussionmentioning

confidence: 99%

Paradigms in chronic subdural hematoma pathophysiology: Current treatments and new directions

Bounajem

Campbell

Denorme

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

Chronic subdural hematomas (CSDHs) are an increasingly common pathology encountered in a neurosurgical trauma practice. Although the operative and nonoperative management of CSDH has been studied extensively, the recurrence rate of CSDH remains high, with no significant decrease in recent years. We undertook a detailed assessment of the known pathophysiological mechanisms by which CSDHs recur to improve our ability to treat patients with this disease successfully. In this review of the literature from the PubMed and Scopus databases, we used the search terms "(pathophysiology) AND chronic subdural hematoma [tiab]" to identify pertinent reviews and articles in English. The results demonstrated a complex inflammatory response to subdural blood, which begins with the formation of a collagen neomembrane around the clot itself. Proinflammatory mediators, such as vascular endothelial growth factor, interleukin-6, interleukin-8, tissue necrosis factor α, matrix metalloproteinases, and basic fibroblast growth factor, then contribute to chronic microbleeding by promoting the formation of fragile, leaky blood vessels, and widening of gap junctions of existing vessels. It is evident that the lack of improvement in recurrence rate is due to pathological factors that are not entirely alleviated by simple subdural evacuation. Targeted approaches, such as middle meningeal artery embolization and anti-inflammatory therapies, have become increasingly common and require further prospective analysis to aid in the determination of their efficacy.

show abstract

“…[12] Muramatsu et al treated four patients of recurrent CSDH with local herbal medicine, Gorei-san successfully without surgery. [20] [21] Retrospective case-control study 198 Corticosteroid Postoperative (methyl) prednisolone 0.5 mg/kg daily for 1 month Berghauser Pont et al, 2012 [22] Retrospective cohort study 496 Corticosteroid Extended preoperative corticosteroid administration Chan et al, 2015 [23] Randomized controlled study 248 Corticosteroid Dexamethasone 4 mg q6h for 4 days, then 2 mg tds for 3 days, then 1 mg bd for 3 days Xu et al, 2015 [24] Retrospective 26 Corticosteroid Local application of methylprednisolone sodium succinate after surgery Tanweer et al, 2016 [25] Retrospective analysis 14 Tranexamic acid Oral tranexamic acid 650 mg daily Hirashima et al, 2002 [26] Prospective case-control study 48 Etizolam 15 patients in etizolam group received 3.0 mg etizolam orally per day for 30 days after surgery…”

Section: Xuefuzhuyutangmentioning

confidence: 99%

The role of medical treatment in chronic subdural hematoma

Thotakura

Marabathina

2018

Asian J Neurosurg

View full text Add to dashboard Cite

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.

show abstract

Local application of corticosteroids combined with surgery for the treatment of chronic subdural hematoma

Cited by 5 publications

References 20 publications

The conservative and pharmacological management of chronic subdural haematoma: a systematic review

The conservative and pharmacological management of chronic subdural haematoma: a systematic review

Paradigms in chronic subdural hematoma pathophysiology: Current treatments and new directions

The role of medical treatment in chronic subdural hematoma

Contact Info

Product

Resources

About