The role of medical treatment in chronic subdural hematoma

Thotakura, Amit Kumar; Marabathina, Nageswara Rao

doi:10.4103/ajns.ajns_13_17

Cited by 15 publications

(4 citation statements)

References 42 publications

(85 reference statements)

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“…Such management includes frequent follow-up imaging, reversal and discontinuation of anticoagulation, and often the administration of corticosteroids (10,(26)(27)(28)(29)(30)(31)(32)(33)(34). Steroids are thought to inhibit the formation of the neomembrane and neovessels by suppressing both fibrinolysis and inflammation (35). However, treatment of cSDHs with corticosteroids has yielded mixed results.…”

Section: Demographic Characteristics and Treatmentmentioning

confidence: 99%

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

et al. 2020

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Chronic subdural hematoma (cSDH) is a common disease process associated with significant morbidity that occurs most often in elderly patients. Asymptomatic patients are typically treated conservatively, with surgical intervention reserved for patients with symptomatic and/or large hematomas that cause brain compression. However, conservatively managed cSDH cases frequently progress, and surgical evacuation of cSDH is associated with high rates of complication and recurrence. Recently, successful treatment of cSDH via middle meningeal artery (MMA) embolization has been reported in small case series and case reports. This article reviews the existing literature on MMA embolization for cSDH and discusses the need for randomized control trials and/or large prospective studies to establish the efficacy of MMA embolization for this disease.

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Section: Demographic Characteristics and Treatmentmentioning

confidence: 99%

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

et al. 2020

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“…Most previous studies of CSDH treatment with Gorei-san have focused on its use to prevent recurrence after surgical treatment. 4 , 16 ) Few studies have considered using Gorei-san to shrink CSDH. 3 , 10 , 11 ) Furthermore, the effects of Gorei-san found in previous research are uncertain because most have been case reports or small case series with no control group.…”

Section: Discussionmentioning

confidence: 99%

Conservative Treatment of Chronic Subdural Hematoma with Gorei-san

Nakao

Marushima

Fujita

et al. 2023

Neurol. Med. Chir.(Tokyo)

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Most asymptomatic patients with chronic subdural hematoma (CSDH) are followed conservatively but can require surgical treatment if the hematoma expands. We conducted a retrospective evaluation of the effect of Gorei-san on CSDH. This study included patients treated between April 2013 and March 2015. In total, 289 patients were diagnosed with CSDH and 110 patients received conservative management. Finally, 39 patients who met the requirements were registered. We retrospectively examined the age, gender, medical history, hematoma thickness, clarity of sulci below hematomas, and midline shift of the patients. The primary outcome was the median surgery-free interval, and the secondary results were the rate of CSDH shrinkage and surgery avoidance. A comparison of patient characteristics between the Gorei-san (G) and non-Gorei-san (NG) groups found no significant differences in the percentage of men, average ages, past history, thickness of CSDH (15.0 ± 3.1 mm vs. 15.3 ± 2.6 mm, p = 0.801), or midline shift (2.0 ± 2.7 mm vs. 4.0 ± 5.0 mm, p = 0.230). The median surgery-free interval was significantly different between the G and NG groups [n. r. vs. 41 days (95% CI: 5-79), log-rank p = 0.047]. The CSDH avoidance rate was not significantly different between the two groups (70.0% vs. 34.4%, p = 0.071). Additionally, the CSDH shrinkage rate was significantly different between the two groups (60.0% vs. 10.3%, p = 0.004). This retrospective study demonstrated that CSDH treatment with Gorei-san reduces hematoma significantly more than treatment that does not include Gorei-san.

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“… 18 One systematic review of all conservative management methods concluded that they could be employed only in small, unorganized lesions, where the neurological status was stable. 44 …”

Section: Reevaluating the Standard Approaches To M ...mentioning

confidence: 99%

Middle Meningeal Artery Embolization: A Paradigm Shift in Approach of Chronic Subdural Hematoma

Hanif¹,

Farook²,

Suriya³

et al. 2022

Journal of Community Hospital Internal Medicine Perspectives

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Chronic subdural hematoma (SDH) is commonly seen in the aged population. It is hypothesized to occur due to damage to the dural border cells, resulting in an inflammation–proliferation reaction. Inadequate repair leads to the formation of an external layer of cells and fragile capillaries, which are vulnerable to damage, contributing to worsening of the condition. Conventionally, asymptomatic chronic SDH was managed by observation, while symptomatic cases by surgical evacuation. However, the recurrence rate of chronic SDH after surgical evacuation was high. The middle meningeal artery (MMA) provides blood supply to the dura mater and feeds the capillaries of the membranes covering the SDH. MMA embolization blocks blood flow to this system and promotes hematoma resolution. In this manuscript, we discuss the underlying pathophysiology and current management options for chronic SDH. We also discuss the existing literature on MMA embolization.

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The role of medical treatment in chronic subdural hematoma

Cited by 15 publications

References 42 publications

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Conservative Treatment of Chronic Subdural Hematoma with Gorei-san

Middle Meningeal Artery Embolization: A Paradigm Shift in Approach of Chronic Subdural Hematoma

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