Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(02): 096-100
DOI: 10.1055/s-0037-1603512
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Chronic Subdural Hematoma Spontaneous Resolution

Resolução espontânea de hematoma subdural crônico
Nícollas Nunes Rabelo
1   Department of Neurosurgery, Hospital Santa Casa, Ribeirão Preto, SP, Brazil
,
Vitor Hugo Honorato Pereira
1   Department of Neurosurgery, Hospital Santa Casa, Ribeirão Preto, SP, Brazil
,
George Santos dos Passos
1   Department of Neurosurgery, Hospital Santa Casa, Ribeirão Preto, SP, Brazil
,
Luciano José Silveira Filho
1   Department of Neurosurgery, Hospital Santa Casa, Ribeirão Preto, SP, Brazil
,
André Luiz Cicilini
2   Medical Student, Universidade de Ribeirão Preto - Unaerp, Ribeirão Preto, SP, Brazil
,
Neiffer Nunes Rabelo
3   Medical Student, Faculdade Atenas, Paracatu, MG, Brazil
,
Luiz Antônio Araujo Dias Junior
1   Department of Neurosurgery, Hospital Santa Casa, Ribeirão Preto, SP, Brazil
,
Carlos Umberto Pereira
4   Department of Neurosurgery, Fundação Beneficiente Hospital de Cirurgia, Aracaju, Sergipe, Brazil
,
Luiz Antônio Araujo Dias
5   Neurosurgeon and Professor, Department of Neurosurgery, Hospital Santa Casa, Ribeirão Preto, SP, Brazil
› Author Affiliations
Further Information

Publication History

05 February 2017

27 March 2017

Publication Date:
22 May 2017 (online)

   Permissions and Reprints

Correction to:

Erratum: Chronic Subdural Hematoma Spontaneous ResolutionArquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(02): 142-142
DOI: 10.1055/s-0037-1603944

Abstract

Introduction Chronic subdural hematoma (CSH) is a hemorrhagic brain injury that persists for more than 21 days after its initial formation. The incidence is predominantly among the elderly population (> 65 years), and varies from 58 to 74/100,000 inhabitants. Spontaneous resolution is considered variable; in the literature series, it is < 1–20% of cases.

Objectives To expose the CSH pathophysiological mechanisms of spontaneous resolution and some treatments that lead to hematoma volume reduction.

Methods Literature review between 1971 to 2016, using the PubMed, Medline, Embase, Scielo, LILACS and Cochrane databases using key-words, with inclusion and exclusion criteria.

Discussion Spontaneous resolution of the CSH pathophysiology is controversial; however, it can be attributed to four basic mechanisms: 1) outer capsule membrane maturation; 2) decreased fibrinolysis; 3) bidirectional flow of blood vessels; and 4) platelet plug. Some drugs, such as mannitol, corticosteroids, tranexamic acid and atorvastatin, contribute to CSH resolution, since they change the capsule membrane permeability, and inhibit the fibrinolytic and inflammatory systems.

Conclusion Spontaneous resolution is unpredictable; in some cases, it has a large temporal evolution (of up to 6 years). It occurs in small or laminar collections, asymptomatic or with transient neurological symptoms, and the pathophysiology is still controversial to this day. Therefore, surgical treatment should remain the first option, even though the conservative management is adopted for some patients. Rigorous outpatient and radiological follow-up are recommended.

Resumo

Introdução O hematoma subdural crônico (HSDC) é uma lesão cerebral hemorrágica que persiste por mais de 21 dias após o começo de sua formação. A sua incidência é predominantemente na população idosa (> 65 anos), e varia de 58–74 /100.000 habitantes, e sua resolução espontânea é considerada rara e variável nas séries da literatura em < 1–20% dos casos.

Objetivos Expor os mecanismos fisiopatológicos que favorecem a resolução espontânea do HSDC e alguns tratamentos que favorecem a redução do volume do hematoma.

Métodos Revisão bibliográfica entre 1971 e 2016, utilizando as bases de dados PubMed, Medline, Embase, Scielo, LILACS e Cochrane, por meio de palavras-chave, com critérios de inclusão e exclusão.

Discussão A fisiopatologia da resolução espontânea dos HSDCs é controversa, porém pode ser atribuída a quatro mecanismos: 1) maturação da membrana externa da cápsula; 2) diminuição da fibrinólise; 3) fluxo bidireccional de vasos sanguíneos; e 4) tampão plaquetário. Alguns medicamentos, tais como manitol, corticoesteroides, ácido tranexâmico e atorvastatina, também podem favorecer a resolução dos HSDCs, uma vez que alteram a permeabilidade da membrana da cápsula e inibem os sistemas fibrinolítico e inflamatório.

Conclusão A resolução espontânea é imprevisível; em alguns casos, tem ampla evolução temporal em até 6 anos. Ocorre em coleções pequenas ou laminares, assintomáticas ou com sintomas neurológicos transitórios, e sua fisiopatologia ainda hoje é controversa. Portanto, o tratamento cirúrgico deve continuar sendo a primeira opção, embora se adote uma conduta conservadora para alguns pacientes. O seguimento ambulatorial e radiológico rigoroso é recomendado.

Keywords

chronic subdural hematoma - spontaneous remission - brain injury

Palavras chave

hematoma subdural crônico - resolução espontânea - lesão cerebral
 

  • References

  • 1 Tanaka Y, Ohno K. Chronic subdural hematoma - an up-to-date concept. J Med Dent Sci 2013; 60 (02) 55-61
    PubMedGoogle Scholar
  • 2 Sousa EB, Brandão LF, Tavares CB. , et al. Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasília, Brazil. BMC Surg 2013; 13: 5
    CrossrefPubMedGoogle Scholar
  • 3 Marcikić M, Hreckovski B, Samardzić J, Martinović M, Rotim K. Spontaneous resolution of post-traumatic chronic subdural hematoma: case report. Acta Clin Croat 2010; 49 (03) 331-334
    PubMedGoogle Scholar
  • 4 Lo W-L, Lee T-C, Fang P-S, Huang Y-H. Chronic subdural hematoma in patients under age 65 years: A comparative study of age cohort. Formos J Surg 2013; 46: 10-14
    CrossrefPubMedGoogle Scholar
  • 5 Gattás GS. Imaging of traumatic brain injury. Rev Med São Paulo 2011; 4: 157-168
    PubMedGoogle Scholar
  • 6 Kim SC, Park SW, Ryoo I. , et al. Contrast-enhanced FLAIR (fluid-attenuated inversion recovery) for evaluating mild traumatic brain injury. PLoS One 2014; 9 (07) e102229
    CrossrefPubMedGoogle Scholar
  • 7 Fujioka S, Matsukado Y, Kaku M, Sakurama N, Nonaka N, Miura G. [CT analysis of 100 cases with chronic subdural hematoma with respect to clinical manifestation and the enlarging process of the hematoma (author's transl)]. Neurol Med Chir (Tokyo) 1981; 21 (11) 1153-1160
    CrossrefPubMedGoogle Scholar
  • 8 Guevara DJE. Resolución espontánea de un hematoma subdural crónico. Cir Cir 2000; 68: 23-25
    PubMedGoogle Scholar
  • 9 Lee GS, Park YS, Min KS, Lee MS. Spontaneous Resolution of a Large Chronic Subdural Hematoma Which Required Surgical Decompression. J Korean Neurosurg Soc 2015; 58 (03) 301-303
    CrossrefPubMedGoogle Scholar
  • 10 Parlato C, Guarracino A, Moraci A. Spontaneous resolution of chronic subdural hematoma. Surg Neurol 2000; 53 (04) 312-315 , discussion 315–317
    CrossrefPubMedGoogle Scholar
  • 11 Baldawa SS, Nayak N. Spontaneous Resolution of Bilateral Chronic Subdural Hematoma. Turk Neurosurg 2015; 25 (05) 835-836
    PubMedGoogle Scholar
  • 12 Göksu E, Akyüz M, Uçar T, Kazan S. Spontaneous resolution of a large chronic subdural hematoma: a case report and review of the literature. Ulus Travma Acil Cerrahi Derg 2009; 15 (01) 95-98
    PubMedGoogle Scholar
  • 13 Kim HC, Ko JH, Yoo DS, Lee S-K. Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy. J Korean Neurosurg Soc 2016; 59 (06) 628-636
    CrossrefPubMedGoogle Scholar
  • 14 Horikoshi T, Naganuma H, Fukasawa I, Uchida M, Nukui H. Computed tomography characteristics suggestive of spontaneous resolution of chronic subdural hematoma. Neurol Med Chir (Tokyo) 1998; 38 (09) 527-532 , discussion 532–533
    CrossrefPubMedGoogle Scholar
  • 15 Naganuma H, Fukamachi A, Kawakami M, Misumi S, Nakajima H, Wakao T. Spontaneous resolution of chronic subdural hematomas. Neurosurgery 1986; 19 (05) 794-798
    CrossrefPubMedGoogle Scholar
  • 16 Rabelo NN, Silveira Filho LJ, Passos GS. , et al. Acute Arterial Hypertension in Patients undergoing Neurosurgery. Arq Bras Neurocir Rio de Janeiro Brazil 2016; 35: 296-303
    PubMedGoogle Scholar
  • 17 Kawano N, Suzuki K. Presence of smooth-muscle cells in the subdural neomembrane. J Neurosurg 1981; 54 (05) 646-651
    CrossrefPubMedGoogle Scholar
  • 18 Ito U, Fujimoto T, Inaba Y. [Formation of the chronic subdural hematoma: 2. A patho-anatomical study of sequel of the traumatic acute subdural hemorrhage (author's transl)]. No Shinkei Geka 1974; 2 (02) 129-143
    PubMedGoogle Scholar
  • 19 Franco RF. Fisiologia da coagulação, anticoagulação e fibrinólise. Medicina 2011; 34: 229-237
    PubMedGoogle Scholar
  • 20 Yamashima T, Yamamoto S, Friede RL. The role of endothelial gap junctions in the enlargement of chronic subdural hematomas. J Neurosurg 1983; 59 (02) 298-303
    CrossrefPubMedGoogle Scholar
  • 21 Loh JK, Howng SL. Electron microscopic study on the outer membrane of chronic subdural hematoma. Kaohsiung J Med Sci 1998; 14 (01) 25-30
    PubMedGoogle Scholar
  • 22 Yadav S, Storrie B. The cellular basis of platelet secretion: Emerging structure/function relationships. Platelets 2017; 28 (02) 108-118
    CrossrefPubMedGoogle Scholar
  • 23 Gjerris F, Schmidt K. Chronic subdural hematoma. Surgery or mannitol treatment. J Neurosurg 1974; 40 (05) 639-642
    CrossrefPubMedGoogle Scholar
  • 24 Suzuki J, Gjeris F, Schmidt K. Letter: Mannitol treatment of subdural hematomas. J Neurosurg 1974; 41 (06) 785-786
    PubMedGoogle Scholar
  • 25 Glover D, Labadie EL. Physiopathogenesis of subdural hematomas. Part 2: Inhibition of growth of experimental hematomas with dexamethasone. J Neurosurg 1976; 45 (04) 393-397
    CrossrefPubMedGoogle Scholar
  • 26 Qian Z, Yang D, Sun F, Sun Z. Risk factors for recurrence of chronic subdural hematoma after burr hole surgery: potential protective role of dexamethasone. Br J Neurosurg 2017; 31 (01) 84-88
    CrossrefPubMedGoogle Scholar
  • 27 Iorio-Morin C, Blanchard J, Richer M, Mathieu D. Tranexamic Acid in Chronic Subdural Hematomas (TRACS): study protocol for a randomized controlled trial. Trials 2016; 17 (01) 235
    CrossrefPubMedGoogle Scholar
  • 28 Kageyama H, Toyooka T, Tsuzuki N, Oka K. Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. J Neurosurg 2013; 119 (02) 332-337
    CrossrefPubMedGoogle Scholar
  • 29 Liu H, Liu Z, Liu Y, Kan S, Yang J, Liu H. Effect of atorvastatin on resolution of chronic subdural hematoma: a prospective observational study [RETRACTED]. J Neurosurg 2016; 29: 1-10 . DOI:10.3171/2015.12.JNS151991
    PubMedGoogle Scholar
  • 30 Wang D, Li T, Wei H. , et al. Atorvastatin enhances angiogenesis to reduce subdural hematoma in a rat model. J Neurol Sci 2016; 362: 91-99
    CrossrefPubMedGoogle Scholar
  • 31 Li T, Wang D, Tian Y. , et al. Effects of atorvastatin on the inflammation regulation and elimination of subdural hematoma in rats. J Neurol Sci 2014; 341 (1-2): 88-96
    CrossrefPubMedGoogle Scholar
  • 32 Wang D, Li T, Tian Y. , et al. Effects of atorvastatin on chronic subdural hematoma: a preliminary report from three medical centers. J Neurol Sci 2014; 336 (1-2): 237-242
    CrossrefPubMedGoogle Scholar
  • 33 Munoz-Bendix C, Pannewitz R, Remmel D. , et al. Outcome following surgical treatment of chronic subdural hematoma in the oldest-old population. Neurosurg Rev 2016 [Epub ahead of print.]
    PubMedGoogle Scholar
  • 34 Rabelo NN, Silveira Filho LJ, Bithencurt BNS. , et al. Differential Diagnosis between Neoplastic and Non-Neoplastic Brain Lesions in Radiology. Arq Bras Neurocir 2016; 35: 45-61
    Article in Thieme ConnectPubMedGoogle Scholar