Understanding chronic subdural hematoma: Pathophysiology

As we consider the medical and surgical treatment options for chronic subdural hematomas (CSDH) the pathophysiology of the disease is of the utmost importance. This disease has been described as early as in the late nineteenth century and was first believed to be caused by a bacterial infection. In the twentieth century, the role of trauma for disrupting dural border cells was essential for the development of CSDH. Various inflammatory, fibrinolytic, and angiogenic factors have advanced the way we surgically manage these pathologies. The histopathological description of neomembranes and selective angiography of the middle meningeal artery have identified the source of microbleeding. Hydrostatic and oncotic pressures within the calvarium are important considerations in patients with macrocephaly, hydrocephalus, and cerebral atrophy. Mechanisms of recurrence and factors that predict recurrence as well as the rationale underlying some of the newer modalities of treatment such as embolization are discussed. CSDH is a fairly common neurosurgical disorder that requires surgical treatment. Understanding the complex pathophysiological mechanisms of this disorder has paved the way for better treatment strategies to treat this condition and decrease the recurrence rate.