Efficacy of the Non-Surgical Treatment of Chronic Subdural Hematoma

Abstract

Chronic subdural hematoma (CSDH) is an abnormal collection of liquefied blood degradation underneath the dura matter that may result in brain tissue compression and subsequent neurologic deficit. CSDH is expected to be increasingly common with our aging population. The average incidence is approximately 13.1 per 100,000 people, but reaches 58 per 100,000 among those who are 70 years of age or older. Since surgery is effective for removing CSDH and reducing the associated neurological deficits, its application is limited by contraindications, the old age of patients, preexisting comorbidities and there is also the high risk of recurrence. The conservative options for the treatment of CSDH are worth investigating and are demonstrating promising results in well selected patients. The normal subdural space is maintained by dural border cells that tether the dura to the arachnoid. Chronic subdural hematoma is preceded by disruption of this gap, either spontaneously or secondary to trauma. Once this disruption occurs, there are a constellation of events, including an inflammatory process leading to the development of neomembranes in addition to incomplete resorption of the hemorrhage that leads to CSDH formation.