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. 2022 Oct 25;63(1):1–8. doi: 10.2176/jns-nmc.2022-0207

Chronic Subdural Hematoma: ―Evolution of Etiology and Surgical Treatment―

Masaaki UNO 1
PMCID: PMC9894619  PMID: 36288974

Abstract

In this paper, I review the historical changes in the etiological concepts and surgical treatments for chronic subdural hematoma (CSDH) across the world and in Japan. I also examine future problems associated with its surgical procedures and medical costs. CSDH was first reported by Wepfer in 1657 as “delayed apoplexy.” In 1857, Virchow described the famous concept of so-called “pachymeningitis hemorrhagica interna.” He considered that the etiology of CSDH involved inflammation. In 1914, Trotter described the origin of CSDH as traumatic. Currently, CSDH is considered to arise with a first leak of blood from dural border cells after mild trauma. Inflammatory cells are then drawn to the border cell layer. At this point, new membranes form from activated inflammation; then, the hematoma enlarges, promoted by angiogenic factors and new capillaries. In 1883, Hulke reported successful trepanning of a patient with CSDH. Burr holes and craniotomy for removal of the hematoma were subsequently reported, and new methods were developed over the course of several decades around the world. In Japan, after the first report by Nakada in 1938, many Japanese pioneering figures of neurological surgery have studied CSDH. After Mandai reported the middle meningeal artery embolization in 2000, this method is now considered useful as an initial or second treatment for CSDH. However, the age of patients is increasing, so more minimally invasive surgeries and useful pharmacotherapies are needed. We must also consider the costs for treating CSDH, because of the increasing numbers of surgical cases.

Keywords: chronic subdural hematoma, etiology, surgical treatment, outcome, history

Introduction

Chronic subdural hematoma (CSDH) is a common disease that is increasingly treated surgically both around the world and in Japan due to the superaging of society.1-4) From ancient times, such as the time of the Inca civilization in South America, treatments have been provided for CSDH, but the disease still has not been overcome. For over 350 years, great figures of medical history have struggled in finding the best treatment for this disorder and have argued about its etiology. The etiological concepts and surgical treatment applied to this disease have evolved over time, even though therapeutic methods have not been perfected and the recurrence rate is regrettably not 0%.

Recently, the number of articles about CSDH have increased exponentially.5) Thus, in this paper, I review the historical changes in the etiological concepts and surgical treatments for CSDH around the world and in Japan and examine future problems associated with surgical procedures and medical costs for CSDH.

Changes in the Etiology of CSDH

Although trephination was developed as early as the Neolithic era, no conclusive evidence has been found to confirm whether this trephination was used as a therapeutic maneuver.6,7) An Egyptian female mummy showing signs of trephination examined by dissection in 1975 was found to have had a subdural hematoma.8) Presumably humankind has been afflicted by CSDH since the ancient times. Johann Jacob Wepfer, a pathologist in Northern Switzerland, first reported two cases of CSDH in 1657.7,9-11) The 1675 edition of his textbook reported on cases in detail.12) He described accumulation of serum between the dura and the pia mater in two cases and considered the cause to be “delayed apoplexy”.12) Eighty-six years after Wepfer's paper, Morgagni reported a case of bleeding between the dura mater and arachnoid membrane in CSDH.10,13) CSDH was thought to involve a stroke-like etiology in those days.9)

In 1857, Virchow described the famous concept of so-called “pachymeningitis hemorrhagica interna.”14) He found recent bleeding within the old membrane in CSDH cases. He also advocated the notion that CSDH resulted from a generalized inflammatory disease. For a long time, this theory held sway. In 1868, Kremiansky reported 50 autopsy cases of “pachymeningitis hemorrhagica interna” and supported Virchow's theory.10,15) He also proposed drinking alcohol as one cause of CSDH.10,15) After Virchow's article, for almost 60 years, the etiology of CSDH was considered inflammatory disease.7,9,10)

By the end of the nineteenth century and beginning of the twentieth century, several physicians had recognized that most patient with CSDH had a history of trauma.9,10,16,17) In 1914, Trotter reported that CSDH had a traumatic origin.18) He attributed the hemorrhage to bleeding of the bridging vein to the superior sagittal sinus.18) However, many researchers stated objections to his opinion that the bridging vein around the superior sagittal sinus was the origin. After that report, in Western countries, CSDH became widely recognized. Horrax and Poppen reported that the frequency and recognition of CSDH increased in the 1930s.19) In 1932, Gardner reported expansion of an original clot through osmotic attraction of cerebrospinal fluid by blood within the hematoma neomembranes.20)

In 1946, Inglis reported the importance of the two layers in CSDH.21) Before the formation of the two new layers, leakage of blood from “dural border cells” between the arachnoid and dura mater represents the initiating step of CSDH.22,23) Many studies have investigated the etiology of CSDH. In general, CSDH assumes brain atrophy by aging and/or drinking as a baseline state, and the first bleeding is noted to occur in dural border cells following mild trauma (sometimes mild enough that it is ignored by the patient); then, inflammatory cells are drawn to the border cell layer. At this point, new membranes (first the outer membrane and then the inner membrane) form from activated inflammation with or without additional mild trauma. Angiogenic factors promote the formation of new capillaries within the outer membrane, and the hematoma gradually enlarges. Historical changes in the etiological concept are summarized in Table 1, and the contemporary understanding of the pathophysiological process underlying CSDH is shown in Fig. 1.24-26)

Table 1.

Historical changes in the etiological concept of CSDH

Year Author Etiological concept of chronic subdural hematoma Expressions in papers
1657 Wepfer JJ12) Apoplex etiology “delayed apoplexy” Serum accumulation between the dura and pia mater
1761 Morgagni GB13) Delayed bleeding between the meninges Bleeding between the dura mater and arachnoid membrane
1857 Virchow R14) Chronic inflammation Pachymeningitis hemorrhagica interna
1868 Kremiansky J15) Inflammation + alcoholism Alcoholism is an important etiological factor
1914 Trotter W18) Traumatic origin An injury “so trivial as to escape attention” caused tearing of a vein
1932 Gardner WJ20) Osmotic gradient theory Raised osmotic gradient causes transport of CSF into the subdural sac after encapsulation of the original hematoma
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CSDH: chronic subdural hematoma, CSF: cerebrospinal fluid

Fig. 1.

Fig. 1

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Contemporary etiological concept of chronic subdural hematoma.

A: Anatomical schema of dural border cells. These cells exist between the arachnoid and dura mater.

B: After minor trauma, bleeding occurs from dural border cells.

C: After inflammatory reaction and additional minor trauma, the subdural space is noted to enlarge.

D: Blood leaks and inflammatory reactions are repeated; then, an outer membrane forms. Next, an inner membrane forms. Granulation and angiogenesis of the membrane gradually induce thickening of the dural border cell layer.

E: The outer membrane participates in the enlargement of the hematoma associated with various actions, and the inner membrane participates in liquefaction of the hematoma. These reactions lead to the enlargement of the hematoma and, ultimately, formation of the chronic subdural hematoma.

The etiology of CSDH has not yet been completely solved, but it has been elucidated step by step through the insightful studies of pioneers.

Historical Changes in the Surgical Treatment of CSDH

In the classical era, Hippocrates performed trepanning as a surgical treatment on the parietal portion of the skull in a patient with spontaneous blindness. During this operation, liquid hematoma was discharged.8,10) In 1883, Hulke reported trepanning as a successful surgical treatment of a patient with traumatic head injury.10,27) His report described “evacuation of inflammatory fluid by incision through the dura mater.”10,27)

In 1914, Trotter reported two cases of patient with CSDH and an edematous disk in the ocular fundus in which he removed the hematoma by craniotomy. These patients reportedly returned to normal life.18) In 1925, Putnam and Cushing reported 50 cases of CSDH treated by craniotomy.28) They used the term “chronic subdural hematoma.”28) From this report, craniotomy became the first option for the treatment of CSDH for several years.9,10)

Horrax and Poppen reported good results for CSDH treated by burr hole and irrigation with saline between 1935 and 1937.19) McKissock et al. and Cameron et al. also reported good outcomes by burr hole and irrigation, so this surgery replaced craniotomy as the first-line treatment for CSDH.29,30) Hematoma removal by craniotomy was performed for only limited cases, such as encapsulated hematoma or hematoma with multiple membranes.30,31)

The twist drill technique, as a minimally invasive surgery, was developed by Cone at the Montreal Neurological Institute around 1940. However, the original technique was not published.32) Rand et al. reported the safe use of the twist drill technique for 49 cases of CSDH.32) Following that report, several neurosurgeons adopted the technique for CSDH.33,34)

Recently, endoscopic hematoma evacuation was introduced for coagulated hematoma, multiple septal membranes in the hematoma, and recurrent CSDH.35-37) The first endoscopic treatment for CSDH was described by Karakhan in 1988.38) Since that paper, several studies have reported the safe management of CSDH by endoscopic surgery.36,37,39) Amano et al. reported that the incidence of postoperative rebleeding and reoperation was significantly lower with endoscopic surgery than in controls treated without an endoscope.36) On the other hand, Yan et al. reported that this method has failed to reduce the recurrence rate.40) Thus, it is deemed crucial that surgeons must recognize the advantages and risks of each approach, such as cortical damage by the endoscope and the longer operation time.

In 2000, Mandai et al. first reported middle meningeal artery (MMA) embolization using polyvinyl alcohol particles for protection against recurrence.41) Since that paper, many reports worldwide have described the usefulness of MMA embolization to eliminate blood supply to the membrane in CSDH.

This method was initially performed as adjuvant treatment before or after standard surgery for recurrent CSDH. Most reports involved small case series and were performed for high-risk patients who were elderly, had been receiving antithrombotic agents, or had thrombocytopenia or coagulation disorders. Recurrences were consistently uncommon, but indications for MMA embolization were found to differ among the reports.42-46) In 2017, Kim reported 20 cases of MMA embolization for recurrent CSDH.47) In 2018 and 2019, Ban et al. and Link et al. reported large case series of MMA embolization.48,49) They first performed MMA embolization to prevent surgery in patients with paucisymptomatic CSDH as prophylaxis against recurrence after the initial surgery. Moreover, they showed that standalone MMA embolization was successfully achieved in almost all cases.48,49) In 2020, Ng et al. described the first randomized study of CSDH allocating patients to receive surgery alone or surgery plus MMA embolization, revealing that surgery plus MMA embolization reduced the time needed for CSDH absorption.50) Kan et al. have also presented a large, multicenter MMA embolization series in the United States, including 138 patients.51) Most cases represented first-time CSDH intervention, and 90% of the patients in this series experienced favorable functional outcomes.51) In 2020, Rajah et al. reported the utility and safety of transradial MMA embolization in a study including 46 patients with CSDH.52) Most cases (80.4%) were performed as primary treatment for CSDH using Onyx. As per the findings, transradial MMA embolization was safe and effective for elderly patients with CSDH.52) Figure 2 shows a summary of reports regarding MMA embolization for CSDH since 2000.

Fig. 2.

Fig. 2

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Historical review of reports from around the world regarding middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH).

In summary, simple burr hole surgery remains to be the first choice for CSDH, but the twist drill technique and a new variation called the “Hollow screw system” are attracting significant attention as less invasive surgeries for elderly patients with CSDH.53) The endoscope is used for recurrent or more complicated hematoma cases. Recently, MMA embolization has been considered a promising method of treatment for patients with initial and/or recurrent CSDH. In the future, randomized studies regarding the efficacy of MMA embolization for patients with new CSDH will be needed, and the indications for MMA embolization should be established. Table 2 summarizes reports from around the world regarding the surgical treatment of CSDH.

Table 2.

Records and reports from around the world regarding the surgical treatment of CSDH

Year Authors Surgical treatment
12,000 BC Trepanation (therapeutic or magical ceremony)
460-377 BC Hippocrates10) Parietal trepanation
1883 Hulke27) Successful surgical treatment of trepanning
1914 Trotter W18) Removal of hematoma by craniotomy
1925 Putnam and Cushing28) Fifty cases of CSDH treated by craniotomy
1937 Horrax and Poppen19) Good result of CSDH treatment by burr hole and irrigation with saline
1966 Rand BO32) Use of twist drill technique for 49 cases of CSDH
1988 Karakhan VB38) First endoscopic treatment for CSDH
2000 Mandai S41) Middle meningeal artery embolization for recurrent CSDH
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CSDH: chronic subdural hematoma

Historical Review of Treatments for CSDH in Japan

In Japan, a case report of CSDH were first published by Professor Nakada in 1938.54) Professor Nakada from Niigata Medical University reported a case of 40-year-old man who presented with headache and confused state with a history of head trauma 4 months earlier. He then diagnosed this patient with CSDH and removed the hematoma and outer and inner membranes using a 6-cm-diameter craniotomy under general anesthesia. This patient was discharged from the hospital without neurological deficit.54) Several case reports were published following this paper, although all of the papers are written in Japanese.55-59) In 1943, Professor Araki from Kyoto University reported the five cases of CSDH (three of adults, two of infants).55) In 1951, Morita from Yokosuka Kyosai Hospital and Shimizu from the University of Tokyo reported cases of CSDH treated by craniotomy.56,57) Neither of those case reports used the word “chronic.” The authors instead referred to “subdural hematoma,” although the presenting illness and operative findings were typical of CSDH and the hematoma was removed via craniotomy.56,57) Suzuki et al. from Tohoku University reported ten cases of CSDH, but two were subacute cases.59) They mainly performed craniotomy, and the mortality rate was 20%.59) Since then, according to our search of the literature, Professor Kitamura from Kyushu University reported more than ten cases of CSDH for the first time in 1959.60) According to that paper, they performed placement of two burr holes and irrigation in 11 of the 17 cases and craniotomy and removal of the membranes in the remaining 6 cases.60) In 1963, Professor Moriyasu reported 30 cases of CSDH, treated mainly by burr hole (one or two) and irrigation.61) In contrast, Kondo reported 21 cases of CSDH, which were all treated using craniotomy.62) Okada and Kawabuchi described surgical treatment for 123 cases of CSDH at Gunma University Hospital.63) They operated on 69 patients between 1955 and 1967 using large craniotomy.63) Since 1968, burr holes and irrigation had mainly been used, showing no significant difference in postoperative outcomes among the two methods.63) Miyazaki et al. from Sapporo Medical University reported treatment of CSDH by placement of a 5-cm-diameter bone window and irrigation of the hematoma.64) However, all these papers are also written in Japanese.

Professors Suzuki and Takaku from Tohoku University Hospital wrote the first report of CSDH in English in 1970.65) They reported nonsurgical treatment comprising osmotherapy with 20% mannitol for 23 consecutive male patients with CSDH.65) In 1972, Professor Hirakawa et al. from the University of Tokyo reported 309 cases of CSDH between 1948 and 1972.66) They then performed large craniotomy and removal of the hematoma with capsule in 137 cases, burr hole surgery and irrigation in 133 cases, and small craniotomy and irrigation of the hematoma without removing the capsule in 33 cases. They concluded that burr hole surgery represented a superior method because the operative outcomes were better, and no differences in postoperative social activities were evident among the three groups.66) Professor Waga from Kyoto University reported on 24 patients over 60 years old with CSDH between 1963 and 1972.67) During that period, only four patients were over 70 years old, and women comprised only 12.5% (3/24). All patients were diagnosed by angiography, and in 20 of the 28 lesions, the hematoma was removed via burr hole surgery (two burr holes were used in 10 of 20 cases). The outcomes of surgical treatment were good; however, these patients did not include any on anticoagulant therapy or hemodialysis.67) After these early reports from Japan, many pioneering figures in Japanese neurological surgery have examined CSDH.

From 1980 to 2000, surgical treatment for protection against recurrent CSDH improved. Aoki described a tapping and irrigation method that was performed through the skin in 1984.68) This tapping was performed at the bedside and used a specially designed needle. Aoki described a lower recurrence rate compared to burr hole or twist drill surgeries. Aoki has also reported replacement of the hematoma with oxygen via percutaneous subdural tapping.69) Kitakami et al. reported carbon dioxide replacement of CSDH using single burr hole irrigation. They described the hematoma cavity and gas as having disappeared the next day.70)

As mentioned above, Mandai et al. reported MMA embolization for protection against recurrence in 2000. I emphasize that this was the first successful report of MMA embolization for CSDH. Table 3 shows a summary of reports from Japan.

Table 3.

A summary of reports from Japan regarding the surgical treatment of CSDH

Year Authors Reports of surgical treatment
1938 Nakada M54) A case report of CSDH treated by craniotomy*
1943 Araki C55) Five cases report of CSDH treated by craniotomy*
1951 Morita M56) Two cases of CSDH treated by craniotomy*
1951 Shimizu K57) A case report of CSDH treated by craniotomy*
1956 Suzuki J59) Ten cases of CSDH treated by craniotomy and burr hole surgery*
1959 Kitamura K60) Evaluation of 17 cases of CSDH treated by burr hole and craniotomy*
1962 Kondo S62) Evaluation of 21 cases of CSDH treated by craniotomy*
1963 Moriyasu M61) Evaluation of 30 cases of CSDH mainly treated by burr hole surgery*
1963 Miyazaki Y64) A 5-cm-diameter bone window and irrigation of hematoma*
1972 Hirakawa K66) Evaluation of 309 cases of CSDH treated by craniotomy and burr hole surgery
1972 Waga S67) Evaluation of 24 cases of CSDH in patients over 60 years old treated by burr hole surgery
1973 Okada K63) Evaluation of 123 cases of CSDH treated by craniotomy and burr hole surgery*
1984 Aoki N68) Tapping and irrigation method
1992 Aoki N69) Replacement of hematoma with oxygen via percutaneous subdural tapping
1995 Kitakami A70) Replacement of hematoma with carbon dioxide
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CSDH: chronic subdural hematoma

* Paper is written in Japanese.

Irrigation has generally been performed using normal saline or Ringer's solution. On the other hand, artificial cerebrospinal fluid (ACF) has been used for irrigation in CSDH burr hole surgery. Several studies have shown that irrigation using ACF reduces the recurrence rate compared with irrigation using normal saline.71,72) Toi et al. conducted a prospective multicenter, randomized study that investigated whether the recurrence rate of CSDH was decreased in an ACF group compared with a normal saline group and to verify the safety of ACF as an irrigation solution for CSDH surgery.73) They concluded that no differences in recurrence rate or time to recurrence were noted between the ACF and normal saline groups. ACF was considered to offer sufficient safety as an irrigation fluid for CSDH.73)

Problems with Surgical Treatment for CSDH

To date, several different approaches have been attempted to prevent recurrence of CSDH. Examples of these approaches include irrigation methods, placement of a drain into the hematoma cavity or subgaleal space, propping the patient's bed up after surgery, and medical treatment with or without surgery.1,5,74-76) Nowadays, patients are getting older,1) so less invasive surgeries and better pharmacotherapies will be needed in the future.

We must also consider the costs for the treatment of CSDH, because of the increasing number of surgical cases. Rauhala et al. reported the cost of CSDH in the Pirkanmaa Region of Finland.77) According to their study, the mean total cost from first hospital admission until final follow-up visit per patient treated surgically was 5250 € (median, 3810 €), with means of 3820 € (median, 3370 €) per patient with no recurrence and 8850 € (median, 7110 €) per patient with recurrence. They concluded that reducing recurrences is crucial to lessen both complications and costs.77) Moreover, while reducing the length of the hospital stay is crucial, elderly patients often experience difficulty returning home directly from the hospital.2,78) If patients are transferred to a nursing home or rehabilitation hospital more frequently in the future, costs will thus increase further. We must therefore aim to shorten the duration of hospitalization and accelerate the process of returning patients home.

Conclusion

In this study, I reviewed the historical changes in the etiological concepts and surgical treatments for CSDH around the world and in Japan. Many pioneering figures have examined CSDH, even though therapeutic methods have not been perfected. The age of patients is increasing; thus, more minimally invasive surgeries and useful pharmacotherapies are needed. We must also consider the costs for treating CSDH, because of the increasing numbers of surgical cases.

Conflicts of Interest Disclosure

Author has no conflicts of interest to declare regarding this study or its findings.

References

  • 1).Uno M, Toi H, Hirai S: Chronic subdural hematoma in elderly patients: is this disease benign? Neurol Med Chir (Tokyo) 57: 402-409, 2017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2).Toi H, Kinoshita K, Hirai S, et al. : Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database. J Neurosurg 128: 222-228, 2018 [DOI] [PubMed] [Google Scholar]
  • 3).Rauhala M, Luoto TM, Huhtala H, et al. : The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg 132: 1147-1157, 2019 [DOI] [PubMed] [Google Scholar]
  • 4).Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N: Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir (Tokyo) 32: 207-209, 1992 [DOI] [PubMed] [Google Scholar]
  • 5).Edlmann E, Holl DC, Lingsma HF, et al. : Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach. Acta Neurochir (Wien) 162: 763-776, 2020 [DOI] [PubMed] [Google Scholar]
  • 6).Marino R Jr, Gonzales-Portillo M: Preconquest Peruvian neurosurgeons: a study of Inca and pre-Columbian trephination and the art of medicine in ancient Peru. Neurosurgery 47: 940-950, 2000 [DOI] [PubMed] [Google Scholar]
  • 7).Lee KS: History of chronic subdural hematoma. Korean J Neurotrauma 11: 27-34, 2015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8).Riddle JM, Ho KL, Chason JL, Schwyn RC: Peripheral blood elements found in an Egyptian mummy: a three-dimensional view. Science 192: 374-375, 1976 [DOI] [PubMed] [Google Scholar]
  • 9).D'Errico AP, German WJ: Chronic subdural hematoma. Yale J Biol Med 3: 11-20, 1930 [PMC free article] [PubMed] [Google Scholar]
  • 10).Weigel R, Krauss JK, Schmiedek P: Concepts of neurosurgical management of chronic subdural haematoma: historical perspectives. Br J Neurosurg 18: 8-18, 2004 [DOI] [PubMed] [Google Scholar]
  • 11).Hoessly GF: Intracranial hemorrhage in the seventeenth century: a reappraisal of Johann Jacob Wepfer's contribution regarding subdural hematoma. J Neurosurg 24: 493-496, 1966 [PubMed] [Google Scholar]
  • 12).Wepfer JJ: In: Obsevartiones anatomicae ex cadaveribus eorum, quossustudit apoplexia cum exercitatione de eius loco agffecto. Waldkirch Alexandri Riedingii, Schaffhausen, 1675 [Google Scholar]
  • 13).Morgagni GB: In: De sedibus et causis morborum. E Lovanii, Venice, 1761 [Google Scholar]
  • 14).Virchow R: Das Haematom der Dura mater. Verb Phys Med Ges Wuerzburg 7: 134-142, 1857 [Google Scholar]
  • 15).Kremiansky J: Uber die Pachymeningitis interna haemorrhagica bei Menschen und Hunden. Arch Path Anat 42: 129-161, 1868 [Google Scholar]
  • 16).Taarnhoj P: Chronic subdural hematoma; historical review and analysis of 60 cases. Cleve Clin Q 22: 150-156, 1955 [DOI] [PubMed] [Google Scholar]
  • 17).Scheinberg SC, Scheinberg LC: Early description of chronic subdural hematoma; etiology, symptomatology, and treatment. J Neurosurg 21: 445-446, 1964 [DOI] [PubMed] [Google Scholar]
  • 18).Trotter W: Chronic subdural hæmorrhage of traumatic origin, and its relation to pachymeningitis hæmorrhagica interna. Br J Surg 2: 271-291, 1914 [Google Scholar]
  • 19).Horrax G, Poppen JL: The frequency, recognition and treatment of chronic subdural hematomas. N Engl J Med 216: 381-385, 1937 [Google Scholar]
  • 20).Gardner WJ: Traumatic subdural hematoma, with particular reference to latent interval. Arch Neurol Psychiatry 27: 847-858, 1932 [Google Scholar]
  • 21).Inglis K: Subdural haemorrhage, cysts and false membranes; illustrating the influence of intrinsic factors in disease when development of the body is normal. Brain 69: 157-194, 1946 [DOI] [PubMed] [Google Scholar]
  • 22).Kolias AG, Chari A, Santarius T, Hutchinson PJ: Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol 10: 570-578, 2014 [DOI] [PubMed] [Google Scholar]
  • 23).Mack J, Squier W, Eastman JT: Anatomy and development of the meninges: implications for subdural collections and CSF circulation. Pediatr Radiol 39: 200-210, 2009 [DOI] [PubMed] [Google Scholar]
  • 24).Feghali J, Yang W, Huang J: Updates in chronic subdural hematoma: epidemiology, etiology, pathogenesis, treatment, and outcome. World Neurosurg 141: 339-345, 2020 [DOI] [PubMed] [Google Scholar]
  • 25).Tamura R, Sato M, Yoshida K, Toda M: History and current progress of chronic subdural hematoma. J Neurol Sci 429: 118066, 2021 [DOI] [PubMed] [Google Scholar]
  • 26).Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ: Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 14: 108, 2017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27).Hulke : Severe blow on the right temple, followed by right hemiplegia and coma, and then by spastic rigidity of the left arm; trephinning; evacuation of inflammatory fluid by incision through dura matter; quick disappearance if cerebral symptoms; complete recovery. Lancet 814-815, 1883 [Google Scholar]
  • 28).Putnam TJ, Cushing H: Chronic subdural haematoma. Arch Surg 11: 329-393, 1925 [Google Scholar]
  • 29).McKissock W, Richardson A, Bloom WH: Subdural haematoma. A review of 389 cases. Lancet 1: 1365-1369, 1960 [Google Scholar]
  • 30).Cameron MM: Chronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiatry 41: 834-839, 1978 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31).Markwalder TM: Chronic subdural hematomas: a review. J Neurosurg 54: 637-645, 1981 [DOI] [PubMed] [Google Scholar]
  • 32).Rand BO, Ward AA Jr, White LE Jr: The use of the twist drill to evaluate head trauma. J Neurosurg 25: 410-415, 1966 [DOI] [PubMed] [Google Scholar]
  • 33).Negrón RA, Tirado G, Zapater C: Simple bedside technique for evacuating chronic subdural hematomas. Technical note. J Neurosurg 42: 609-611, 1975 [DOI] [PubMed] [Google Scholar]
  • 34).Tabaddor K, Shulmon K: Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 46: 220-226, 1977 [DOI] [PubMed] [Google Scholar]
  • 35).Du B, Xu J, Hu J, et al. : A clinical study of the intra-neuroendoscopic technique for the treatment of subacute-chronic and chronic septal subdural hematoma. Front Neurol 10: 1408, 2020 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36).Amano T, Miyamatsu Y, Otsuji R, Nakamizo A: Efficacy of endoscopic treatment for chronic subdural hematoma surgery. J Clin Neurosci 92: 78-84, 2021 [DOI] [PubMed] [Google Scholar]
  • 37).Berhouma M, Jacquesson T, Jouanneau E: The minimally invasive endoscopic management of septated chronic subdural hematomas: surgical technique. Acta Neurochir (Wien) 156: 2359-2362, 2014 [DOI] [PubMed] [Google Scholar]
  • 38).Karakhan VB: Experience using intracranial endoscopy in neurologic traumatology. Vestn Khir Im I Grek 140: 102-108, 1988 [PubMed] [Google Scholar]
  • 39).Mobbs R, Khong P: Endoscopic-assisted evacuation of subdural collections. J Clin Neurosci 16: 701-704, 2009 [DOI] [PubMed] [Google Scholar]
  • 40).Yan K, Gao H, Zhou X, et al. : A retrospective analysis of postoperative recurrence of septated chronic subdural haematoma: endoscopic surgery versus burr hole craniotomy. Neurol Res 39: 803-812, 2017 [DOI] [PubMed] [Google Scholar]
  • 41).Mandai S, Sakurai M, Matsumoto Y: Middle meningeal artery embolization for refractory chronic subdural hematoma. Case report. J Neurosurg 93: 686-688, 2000 [DOI] [PubMed] [Google Scholar]
  • 42).Hirai S, Ono J, Odaki M, Serizawa T, Nagano O: Embolization of the middle meningeal artery for refractory chronic subdural haematoma. Usefulness for patients under anticoagulant therapy. Interv Neuroradiol 10: 101-104, 2004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43).Mino M, Nishimura S, Hori E, et al. : Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma. Surg Neurol Int 1: 78, 2010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44).Hashimoto T, Ohashi T, Watanabe D, et al. : Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas. Surg Neurol Int 4: 104, 2013 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45).Link TW, Schwarz JT, Paine SM, Kamel H, Knopman J: Middle meningeal artery embolization for recurrent chronic subdural hematoma: a case series. World Neurosurg 118: e570-e574, 2018 [DOI] [PubMed] [Google Scholar]
  • 46).Ishihara H, Ishihara S, Kohyama S, et al. : Experience in endovascular treatment of recurrent chronic subdural hematoma. Interv Neuroradiol 13: 141-144, 2007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47).Kim E: Embolization therapy for refractory hemorrhage in patients with chronic subdural hematomas. World Neurosurg 101: 520-527, 2017 [DOI] [PubMed] [Google Scholar]
  • 48).Ban SP, Hwang G, Byoun HS, et al. : Middle meningeal artery embolization for chronic subdural hematoma. Radiology 286: 992-999, 2018 [DOI] [PubMed] [Google Scholar]
  • 49).Link TW, Boddu S, Paine SM, Kamel H, Knopman J: Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery 85: 801-807, 2019 [DOI] [PubMed] [Google Scholar]
  • 50).Ng S, Derraz I, Boetto J, et al. : Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption. J Neurointerv Surg 12: 695-699, 2020 [DOI] [PubMed] [Google Scholar]
  • 51).Kan P, Maragkos GA, Srivatsan A, et al. : Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery 88: 268-277, 2021 [DOI] [PubMed] [Google Scholar]
  • 52).Rajah GB, Waqas M, Dossani RH, et al. : Transradial middle meningeal artery embolization for chronic subdural hematoma using Onyx: case series. J Neurointerv Surg 12: 1214-1218, 2020 [DOI] [PubMed] [Google Scholar]
  • 53).Chari A, Kolias AG, Santarius T, Bond S, Hutchinson PJ: Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma. J Neurosurg 121: 176-183, 2014 [DOI] [PubMed] [Google Scholar]
  • 54).Nakada M, Kaneko J: Chronic subdural hematoma. Diagn Treat 25: 12-33, 1938(Japanese) [Google Scholar]
  • 55).Araki C: Chronic subdural hematoma. Rinsho no nippon 11: 23-28, 1943(Japanese) [Google Scholar]
  • 56).Morita M: Two treatment cases of traumatic subdural hematoma. Surgery 13: 43-46, 1951(Japanese) [Google Scholar]
  • 57).Shimizu K: Subdural hematoma. Surgery 13: 284-287, 1951(Japanese) [Google Scholar]
  • 58).Yonesawa T, Numakura M, Takisawa K: Two casses of chronic subdural hematoma. Tohoku Med J 46: 125-127, 1951(Japanese) [Google Scholar]
  • 59).Suzuki J, Kisugi T, Cheng W, Ishibashi T: Subdural hematoma. J Clin Surg 11: 235-239, 1956(Japanese) [Google Scholar]
  • 60).Kitamura K, Kinoshita K: Consideration on chronic subdural hematoma of 17 cases. The Jpn J Clin Exp Med 36: 1619-1623, 1959(Japanese) [Google Scholar]
  • 61).Moriyasu M, Yamamoto T: Chronic subdural hematoma. J Clin Surg 12: 141-148, 1963(Japanese) [Google Scholar]
  • 62).Kondo S: On the pathogenesis of chronic subdural hematoma. Brain Nerve 14: 907-912, 1962(Japanese) [PubMed] [Google Scholar]
  • 63).Okada K, Kawabuchi J: The surgical treatment of chronic subdural hematoma. Comparison between large craniotomy and burr hole craniectomy. Blood Vessels 4: 1369-1376, 1973(Japanese) [Google Scholar]
  • 64).Miyazaki Y, Chiba T, Suematu K, Hagiwara R: Reevaluation of the operation method of chronic subdural hematoma. Shujutsu 17: 939-945, 1963(Japanese) [Google Scholar]
  • 65).Suzuki J, Takaku A: Nonsurgical treatment of chronic subdural hematoma. J Neurosurg 33: 548-553, 1970 [DOI] [PubMed] [Google Scholar]
  • 66).Hirakawa K, Hashizume K, Fuchinoue T, Takahashi H, Nomura K: Statistical analysis of chronic subdural hematoma in 309 adult cases. Neurol Med Chir (Tokyo) 12: 71-83, 1972 [DOI] [PubMed] [Google Scholar]
  • 67).Waga S, Otsubo K, Ishikawa M, Handa H: Chronic subdural hematoma in the aged. Neurol Med Chir (Tokyo) 12: 84-90, 1972 [DOI] [PubMed] [Google Scholar]
  • 68).Aoki N: Subdural tapping and irrigation for the treatment of chronic subdural hematoma in adults. Neurosurgery 14: 545-548, 1984 [DOI] [PubMed] [Google Scholar]
  • 69).Aoki N: A new therapeutic method for chronic subdural hematoma in adults: replacement of the hematoma with oxygen via percutaneous subdural tapping. Surg Neurol 38: 253-256, 1992 [DOI] [PubMed] [Google Scholar]
  • 70).Kitakami A, Ogawa A, Hakozaki S, Kidoguchi J, Obonai C, Kubo N: Carbon dioxide gas replacement of chronic subdural hematoma using single burr-hole irrigation. Surg Neurol 43: 574-577, 1995 [DOI] [PubMed] [Google Scholar]
  • 71).Adachi A, Higuchi Y, Fujikawa A, et al. : Risk factors in chronic subdural hematoma: comparison of irrigation with artificial cerebrospinal fluid and normal saline in a cohort analysis. PLoS One 9: e103703, 2014 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72).Kuwabara M, Sadatomo T, Yuki K, et al. : The effect of irrigation solutions on recurrence of chronic subdural hematoma: a consecutive cohort study of 234 patients. Neurol Med Chir (Tokyo) 57: 210-216, 2017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73).Toi H, Fujii Y, Iwama T, et al. : Determining if cerebrospinal fluid prevents recurrence of chronic subdural hematoma: a multi-center prospective randomized clinical trial. J Neurotrauma 36: 559-564, 2019 [DOI] [PubMed] [Google Scholar]
  • 74).Lee S, Srivatsan A, Srinivasan VM, et al. : Middle meningeal artery embolization for chronic subdural hematoma in cancer patients with refractory thrombocytopenia. J Neurosurg 2021. Online ahead of print [DOI] [PubMed] [Google Scholar]
  • 75).Hutchinson PJ, Edlmann E, Bulters D, et al. : Trial of dexamethasone for chronic subdural hematoma. N Engl J Med 383: 2616-2627, 2020 [DOI] [PubMed] [Google Scholar]
  • 76).Soleman J, Kamenova M, Lutz K, Guzman R, Fandino J, Mariani L: Drain insertion in chronic subdural hematoma: an international survey of practice. World Neurosurg 104: 528-539, 2017 [DOI] [PubMed] [Google Scholar]
  • 77).Rauhala M, Helén P, Huhtala H, et al. : Chronic subdural hematoma-incidence, complications, and financial impact. Acta Neurochir (Wien) 162: 2033-2043, 2020 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 78).Sase T, Furuya Y, Tanaka Y: Hospital discharge arrangements for very elderly patients with chronic subdural hematoma. No Shinkei Geka 48: 1115-1120, 2020(Japanese) [DOI] [PubMed] [Google Scholar]

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