Drug treatment of chronic subdural hematoma

ABSTRACT

Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, whose incidence has been steadily increasing with our aging population. While not common, CSDH can also occur in children. CSDH is often associated with traumatic head injury, but its underlying mechanism remains poorly understood. The first line treatment for CSDH is surgery. However, surgery is contraindicated in some patients and has a high rate of recurrence. Effective non-surgical treatment is therefore highly desirable.

Areas covered: This review discusses the pathogenesis of CSDH and drugs that have been used to treat CSDH either as monotherapy or an adjuvant to surgery, including controlled clinical trials.

Expert opinion: The pathophysiology of CSDH remains poorly understood. Developing effective drug treatments is therefore challenging. Most drugs discussed in this review are evaluated in small clinical studies without sufficient sample size and controls for confounding variables. More controlled clinical trials are therefore needed to carefully evaluate drugs for the non-surgical treatment of CSDH, especially for drugs targeting specific pathogenic pathways of CSDH.

KEYWORDS:

• Chronic subdual hematoma (CSDH)
• pathogenesis
• pharmacotherapy

Article highlights

• The pathogenesis of CSDH is complex and multifactorial.

• Basic science research is needed to define the underlying mechanism of CSDH.

• This complexity has hindered the progress toward developing effective drug treatments of CSDH.

• Multi-center clinical trials are needed to identify effective and safe drugs to non-surgically treat patients with CSDH.

• Combining multiple drugs targeting distinct pathways of CSDH may prove to be more effective than single drug regimen.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

The authors are supported by the National Natural Science Foundation of China via grants 81671221, 81271359 and 81671380.