Editorial: Chronic subdural hematoma: Overview of recent therapeutic advancements

Chronic subdural hematoma: Overview of recent therapeutic advancementsChronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage.With the aging of population-which increases susceptibility to the disease-it is of utmost importance to expand our understanding of the condition and update treatment protocols.Most cases can be managed conservatively, but in those needing surgery, burr hole craniostomy (BHC) remains the most commonly used technique with favorable outcome; craniotomy and hematoma evacuation are reserved for recurrence (1).Given the older age of the affected population and higher prevalence of co-morbidities, more minimally invasive surgery (MIS) options have been proposed, especially in octogenarians.For instance, twist-drill craniostomy (TDC) is reported to have similar efficacy to BHC with a lower complication rate and length of hospital stay (Wei et al.).However, another review showed that while complications, recurrence, cure, and mortality rates were not different between TDC and BHC, TDC was associated with a higher reoperation rate than BHD, especially if not used with a negative suction drainage system (2).In general, superiority of one technique over the other cannot be conferred from the current data and both are efficient and relatively safe tools.Another MIS option is Subdural Evacuating Port System (SEPS).In the proper setting, SEPS can be done outside operating room with comparable complications, mortality, and recurrence rates (Liu et al.).There are also some promising early results with active bone hole drainage systems, as they reduce post-operative pneumatosis (a known recurrence risk factor) (Zhang et al.).Regardless of the technique, high recurrence and reoperation rates (10-25%) still pose a unique challenge (3).Among many, anticoagulant use, presence of mixed hematoma signal densities/intensities on CT/MRI, laminar and separated hematomas, larger hematoma residual post-surgery, and severe brain atrophy are some of the known risk factors for recurrence and reoperation (3) (Tian et al.).In this regard, <50% decrease in hematoma thickness on post-operative CT and <40% brain re-expansion rate on post-operative day 7-9 are associated with higher recurrence rate (3) (Han et al.).