Hematoma subdural crónico:: tratamiento
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is a lack of uniformity in the treatment of CSDH among surgeons in terms of various treatment strategies. The clinical presentation can range from no symptoms to unconsciousness. CSDH is usually diagnosed by c...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | Spanish |
| Published: |
2020
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| Subjects: | |
| Online Access: | https://dialnet.unirioja.es/servlet/oaiart?codigo=7591594 |
| Source: | RECIMUNDO: Revista Científica de la Investigación y el Conocimiento, ISSN 2588-073X, Vol. 4, Nº. 3, 2020, pags. 184-198 |
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| Summary: |
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is a lack of uniformity in the treatment of CSDH among surgeons in terms of various treatment strategies. The clinical presentation can range from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast enhanced computed tomography. Magnetic resonance imaging (MRI) is most sensitive in the diagnosis of bilateral isodense CSDH, multiple flocculations, intrahema-toma membranes, recent bleeding, hemolysis, and capsule size. Contrast CT or enhanced MRI could detect associated primary or metastatic dural diseases. Although in most cases a definitive trauma history can be obtained, some cases may be secondary to a coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., recurrent bleeding, increased exudates from the outer membrane and entrapment of cerebrospinal fluid. been involved in the expan-sion of CSDH. Burr removal is the treatment of choice for uncomplicated CSDH. Most recent trials favor the use of drainage to reduce the recurrence rate. Craniotomy and Twist Drill Craniotomy also have a role in management. A DURAL biopsy should be taken, especially in recurrence and thick outer membrane. Non-surgical treatment is reserved for asymptomatic or high-risk surgical patients. Steroids and angiotensin-converted enzyme inhibitors may also play a role in treatment. The single management strategy is not suitable for all CSDH cases. A better understanding of the nature of pathology, rational selection of an ideal treatment strategy for an individual patient, and identification of the merits and limitations of different surgical techniques could help improve prognosis |
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