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At least 19 recordsLinked to original sources
PubMed2026

Craniotomy versus Endoscopic Membranectomy in the Treatment of Non-Homogeneous Chronic Subdural Hematoma: A Pilot Randomized Parallel-Group Active-Controlled Trial (EMiT CSDH 2).

BACKGROUND: Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with persistent challenges related to recurrence. Endoscopic membranectomy (EM) has shown promising results in managing symptomatic non-homogenous (SNH)-CSDH, but comparative evidence against craniotomy with membranectomy (CM) is lacking. OBJECTIVES: To compare the safety and efficacy of EM versus CM in managing SNH-CSDH. MATERIALS AND METHODS: A pilot randomized parallel-group active-controlled open- labeled superiority trial from September 2023 to November 2024 at Government Kilpauk Medical College, Chennai, India. Sixty patients with SNH-CSDH were randomized into EM and CM groups. Recurrence was the primary outcome. Secondary outcomes included operative time, complications, radiological indices, pain, hospital stay, and functional recovery. All patients were followed for six months. RESULTS: No recurrence was observed in either group at six months. Two CM patients required reoperation on postoperative day one ( P = 0.15). EM was associated with shorter operative time ( P = 0.02), lower incidence of post-operative subdural residual fluid ( P = 0.015), better early hematoma reduction/subdural space reduction index ( P = 0.008), midline shift/symmetry improvement index ( P = 0.001), and lesser surgical site swelling ( P < 0.001). All patients were ambulant and had a Glasgow coma scale (GCS) 15 at discharge and at six months (including reoperated patients). Pain scores and functional recovery were comparable. EM patients had shorter hospital stays ( P = 0.004) and no significant complications. CONCLUSION: EM demonstrated favorable early radiological outcomes, fewer complications, and comparable functional recovery and recurrence versus CM in SNH-CSDH. Independent reproduction and larger multicentric trials are needed for validity and generalizability.

Humans↗
PubMed2026

Efficacy and safety of middle meningeal artery embolization for chronic subdural hematoma: an updated systematic review and meta-analysis focusing on time of intervention.

INTRODUCTION: Chronic subdural hematoma (cSDH) is increasingly prevalent among older adults due to population aging and widespread antithrombotic use. Although burr-hole drainage remains the standard treatment, recurrence rates are substantial. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive strategy to disrupt dural neovascularization and prevent rebleeding. OBJECTIVES: To assess the efficacy and safety of MMAE combined with standard therapy versus standard therapy alone, with stratification by timing of intervention. METHODS: Randomized controlled trials (RCTs) were searched in PubMed, Scopus, and Cochrane Central up to July 2025. Adults with confirmed cSDH were included. The primary outcome was hematoma recurrence or persistence. Secondary outcomes were reoperation, hematoma resorption, serious adverse events, neurological death, mortality, functional independence, and hospital stay. Risk of bias was assessed with RoB-2, and analyses followed PRISMA guidelines (PROSPERO CRD420251112841). RESULTS: Seven RCTs (1,889 patients) were included. Compared with standard therapy, MMAE significantly reduced recurrent or residual cSDH (RR 0.63; 95% CI 0.46-0.85) and reoperation (RR 0.39; 95% CI 0.28-0.56) without increasing serious adverse events (RR 0.87; 95% CI 0.72-1.06), neurological death, mortality, or poor functional outcomes. Hematoma resorption did not differ significantly. Subgroup and sensitivity analyses confirmed the robustness of the results across age, intervention timing, and follow-up duration. CONCLUSION: MMAE combined with standard therapy significantly reduces recurrence and reoperation in cSDH without increasing adverse events or mortality. Benefits appear independent of procedural timing, though larger RCTs with extended follow-up are warranted to define long-term outcomes and optimal use.

Humans↗
PubMed2026

Adjunctive middle meningeal artery embolization for chronic subdural hematoma: A systematic review and meta-analysis of eight randomized trials.

BACKGROUND: Randomized trials suggest that adjunctive middle meningeal artery embolization (MMAE) may reduce recurrence in chronic subdural hematoma (CSDH), but potential sources of variability in treatment effects across studies remain poorly understood. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of MMAE and to explore potential study-level sources of between-study heterogeneity. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials comparing MMAE plus surgery versus surgery alone, following PRISMA guidelines. Trial sequential analysis (TSA) was prespecified to assess the robustness of pooled findings. Exploratory mixed-effects meta-regression was performed to examine whether aggregate study-level mean age and anticoagulation use were associated with variability in recurrence outcomes. RESULTS: Eight trials including 1961 patients were analyzed. MMAE plus surgery was associated with a reduction in recurrence compared with surgery alone (RR 0.63, 95% CI 0.46-0.85; I&#xb2; = 0%), and TSA supported this finding. Although conventional meta-analysis suggested a reduction in reoperation, the TSA findings were more sensitive to analytical assumptions and less robust. Exploratory study-level meta-regression analyses suggested possible associations between recurrence outcomes and mean age or anticoagulation use, although these findings should be interpreted as hypothesis-generating only. Safety outcomes were comparable between groups. CONCLUSIONS: Adjunctive MMAE was associated with reduced recurrence in CSDH. Exploratory analyses evaluating aggregate study-level characteristics were limited by the small number of included trials and the use of aggregate-level data, and should be considered hypothesis-generating only. Further prospective studies are needed to better understand variability in treatment effects.

Humans↗
PubMed1977

[Three cases of chronic subdural hematoma developing after direct aneurysmal surgery (author's transl)].

Three cases of chronic subdural hematoma developing after direct aneurysmal surgery were presented. All patients were males and heavy drinkers. There was no history of head injury after craniotomy. In two of the three cases, the angiography was performed on the 12th postoperative day. An avascular area was already revealed on the postoperative angiograms, but there were no disorders at that time. The intervals between the aneurysmal surgery and the onset of symptoms of chronic subdural hematoma ranged from about two to three months. In this report, the diagnostic criteria for the chronic subdural hematoma resulted from intracranial surgery were also discussed with a consideration on the pathogenesis of this condition.

Alcohol Drinking↗
PubMed1976

Role of local hyperfibrinolysis in the etiology of chronic subdural hematoma.

The authors describe studies performed on material aspirated from chronic subdural hematomas. Patients were given 51Cr-labeled red cells prior to aspiration, and it was possible to demonstrate that the mean daily hemorrhage into the hematoma space amounted to 10.2% of its volume. Immunoelectrophoresis of the aspirated hematoma fluid by monospecific anti-human fibrinogen revealed the presence of fibrin and fibrinogen degradation products that, measured by hemagglutination-inhibition immunoassay techniques, varied between 5.0 and 10,500 mug/ml with an average of 2604 mug/ml in 18 cases. The tissue activator was demonstrated by Todd's histological localization in the outer membrane of the chronic subdural hematoma in 11 cases, but not in the inner membrane. These results indicate that if a clot in the subdural space causes the formation of neomembrane, and excessive fibrinolysis occurs, the subdural clot would not only liquefy, but also enlarge by continuous hemorrhage from the neomembrane. Therefore, local hyperfibrinolysis and continuous bleeding are important in the etiology of the chronic subdural hematoma.

Cerebral Hemorrhage↗
PubMed1979

Physiopathology and a new treatment of chronic subdural hematoma in children.

Chronic collections of fluid in the subdural spaces may result from trauma or may complicate meningitis. The etiological factor, or factors, which contribute to chronicity of subdural fluid in children remains obscure. We postulate that one possible mechanism is the progressive stretching and narrowing of the cortical veins, bridging the subarachnoid and subdural spaces to enter the superior sagittal sinus. This process ultimately leads to thrombosis of these 'hanging veins'. Narrowing and angulation of these veins could result in elevated back pressure favoring the formation of a transudate. 16 children who had progressive and persistent collections of xanthochromic fluid in the subdural spaces secondary to trauma or infection who were treated previously either with subdural tap, burr holes, subdural peritoneal shunt, craniotomy, stripping of membranes and/or a combination of these, were treated by lowering and advancing the superior sagittal sinus with its overlying sagittal suture and performing a duraplasty. This new surgical technique is directed to improve venous drainage from the superior anastomotic vein into the superior sagittal sinus. Angiographic follow-up showed that only 2 patients still have evidence of fluid collection: the rest of the patients showed normal arterial phases, the medullary system was minimally filled and all of these showed remarkable improvement of the venous drainage throughout the superficial cortical veins with no evidence of hanging veins. Intellectual development of these children following lowering of the superior sagittal sinus showed that 8 patients (50%) were normal or above normal; 5 patients (31.2%) were retarded and 3 patients (18.7%) were borderline.

Cerebral Angiography↗
PubMed1977

Intrauterine chronic subdural hematoma.

We discuss a newborn delivered by elective cesarean section who had macrocephaly with severe anemia. The anemia was corrected by exchange transfusion, and the infant, at first, appeared stable but manifested poor feeding and seizures. Transillumination of the skull was negative, although the anterior fontanel was tense. Computerized tomography demonstrated mild hydrocephalus and suggested subdural fluid. Bilateral subdural taps yielded fluid typical for chronic subdural hematoma. To our knowledge, this is the first documented case of intrauterine subdural hematoma developing in the absence of trauma. An analogy is made to the pathogenesis of subdural hematoma after rapid decompression of the ventricular system by shunting procedures for obstructive hydrocephalus.

Chronic Disease↗
PubMedDate not supplied

Chronic subdural hematoma presenting as transient neurologic deficits.

Four patients with symptoms of transient neurological dysfunction were subsequently found to have chronic subdural hematomas (CSDH). The frequency of these episodes diminished significantly after evacuation of the hematoma. The effects of vascular compromise due to the CSDH and to cardiovascular events, more commonly implicated in transient ischemic attacks (TIAs) may be additive. The inclusion of a computerized axial tomographic (CAT) scan in the evaluation of some patients with presumed TIAs is recommended.

Adult↗
PubMed1975

Regional cerebral blood flow in patients with chronic subdural hematomas.

Cerebral blood flow (CBF) was measured by the intra-arterial 133Xenon method in seven patients, aged 55 to 76 years, with chronic subdural hematomas. Before operation, CBF was reduced to an average of 31 ml/100g/min, range 24-38 ml/100g/min. One to 3 weeks after operation, when all had improved, CBF averaged 38 ml/100g/min, range 34-43 ml/100g/min. The reduction of CBF was probably secondary to a reduced metabolic demand. Clinical improvement continued for months after operation.

Aged↗
PubMed1977

Two cases of giant intracerebral aneurysm simulating neoplasm on ct scan; one with coexistent chronic subdural hematoma.

Two cases of giant intracerebral aneurysm are presented. Both exhibit increased absorption values in a circumferential configuration peripherally after the administration of contrast material. In addition, one case demonstrates a coexistent contralateral chronic subdural hematoma. No previous example of intracranial aneurysm exhibiting this configuration on computed tomography has been described in the literature. The operative, computed tomographic, radionuclide and angiographic findings are described and the differential diagnosis discussed.

Brain Neoplasms↗
PubMed1978

Fibrinolytic enzyme in the lining walls of chronic subdural hematoma.

Active plasmin, available plasmin, and total plasminogen were measured by Enzo-diffusion fibirn plate techniques in 11 cases and level of tissue activator and tissue fibrinolytic activities in another 11 cases with chronic subdural hematoma. The values were too small to be measured in some instances. Anti-plasmin in the hematoma was less than in the blood plasma. The outer membrane contained about three times more tissue activator than the dura mater, although the inner membrane contained none. Increased tissue activator, which exudes from the extremely vascular outer membrane, transforms plasminogen into plasmin in subdural hematoma, so that plasmin breaks down fibrin and fibrinogen and induces continuous hemorrhage.

Dura Mater↗