慢性硬膜下血肿形成及复发机制的研究进展

Progress in the Study of the Mechanism of Formation and Recurrence of Chronic Subdural Hematoma

摘要: 慢性硬膜下血肿(chronic subdural hematoma, cSDH)是常见的神经外科疾病，多见于老年人。血肿的进展原因、转化为慢性的过程有其复杂的病理生理机制，并与治疗效果息息相关。目前，慢性硬膜下血肿的主要治疗方法是钻孔引流术，但存在需要再次手术的复发风险，目前术后复发率约9%~37%。目前所认为的血肿复发的主要原因主要是钻孔术后血肿包膜依旧存在，血肿形成的病理生理机制并未被阻断。为降低术后复发率，目前对潜在病理生理学机制的理解已用于新的治疗方法——脑膜中动脉栓塞术(middle meningeal artery embolization, MMAE)。还需要大量研究以确定脑膜中动脉栓塞术是否能成功停止血肿进展过程，从而控制和缓解cSDH。本文就cSDH发生发展过程中的血管生成、炎症反应、纤溶亢进等关键过程以及cSDH复发机制和降低复发率的手术方式进行综述。

Abstract: Chronic subdural hematoma (cSDH) is a common neurosurgical disease, mostly seen in the elderly. The progressive, chronic course of the disease has its own complex pathophysiological mechanisms and is closely related to the outcome of treatment. Currently, the main treatment for chronic subdural hematomas is drilling and drainage, but there is a risk of recurrence requiring reoperation, with current recurrence rates of approximately 9%~37%. The main reason for hematoma recurrence is that the hematoma envelope remains after drilling, and the pathophysiological mechanism of hematoma formation has not been blocked. To reduce the rate of postoperative recurrence, an understanding of the underlying pathophysiological mechanisms has been used in a new therapeutic approach, middle meningeal artery embolization (MMAE). Numerous studies are needed to determine whether MMAE is successful in stopping the process of hematoma generation and thus controlling and alleviating cSDH. This article provides a review of the key processes of angiogenesis, inflammatory response, and hyperfibrinolysis in the development of cSDH, as well as the mechanisms of recurrence of cSDH and new surgical approaches to reduce the recurrence rate.