Affiliation:
1. Department of Morphology, Anatomy and Experimental Medicine, University of Ferrara;
2. Department of Neurosurgery, Sant’Anna University Hospital, Ferrara;
3. Department of Neurosurgery, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Lecce; and
4. Department of Neurosurgery, San Bortolo Hospital, Vicenza, Italy
Abstract
OBJECTIVEChronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.METHODSThe authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were “chronic subdural hematoma,” “conservative treatment/management,” “pharmacological treatment,” “non-surgical,” “tranexamic acid,” “dexamethasone,” “corticosteroid,” “glucocorticoid,” “middle meningeal artery,” “endovascular treatment,” and “embolization.”RESULTSThe authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.CONCLUSIONSThe results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable.
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Subject
Neurology (clinical),General Medicine,Surgery
Cited by
18 articles.
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