Diagnosis and treatment
Chronic subdural hematoma
Hematoma subdural crónico
Miguel Gelabert-González
, María Rico-Cotelo, Eduardo Arán-Echabe
Corresponding author
Servicio de Neurocirugía, Departamento de Cirugía, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
Read
75
Timeswas read the article
13
Total PDF
62
Total HTML
Share statistics
array:24 [ "pii" => "S2387020615002508" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.12.003" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "3222" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;144:514-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 69 "formatos" => array:2 [ "HTML" => 58 "PDF" => 11 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775315000615" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.01.006" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "3222" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;144:514-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 724 "formatos" => array:2 [ "HTML" => 670 "PDF" => 54 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnóstico y tratamiento</span>" "titulo" => "Hematoma subdural crónico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "519" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Chronic subdural hematoma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1493 "Ancho" => 1800 "Tamanyo" => 255826 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tomografía computarizada con diferentes tipos de arquitectura interna de hematoma subdural crónico. A) Homogéneo (hipodenso). B) Homogéneo (isodenso). C) Homogéneo (hiperdenso). D) Laminar. E) Separado. F) Trabecular.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Gelabert-González, María Rico-Cotelo, Eduardo Arán-Echabe" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Gelabert-González" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Rico-Cotelo" ] 2 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Arán-Echabe" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020615002508" "doi" => "10.1016/j.medcle.2015.12.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002508?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315000615?idApp=UINPBA00004N" "url" => "/00257753/0000014400000011/v2_201505100049/S0025775315000615/v2_201505100049/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020615002545" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.12.007" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "3163" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2015;144:520-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 34 "formatos" => array:2 [ "HTML" => 25 "PDF" => 9 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Determinants factors of Spanish researchers mobility in Health Sciences" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "520" "paginaFinal" => "524" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores determinantes de la movilidad de investigadores españoles en Ciencias de la Salud" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Aceituno-Aceituno, Sonia Janeth Romero-Martínez, Patricia Victor-Ponce, José García-Nuñez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Aceituno-Aceituno" ] 1 => array:2 [ "nombre" => "Sonia Janeth" "apellidos" => "Romero-Martínez" ] 2 => array:2 [ "nombre" => "Patricia" "apellidos" => "Victor-Ponce" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "García-Nuñez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314008124" "doi" => "10.1016/j.medcli.2014.10.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314008124?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002545?idApp=UINPBA00004N" "url" => "/23870206/0000014400000011/v1_201602060036/S2387020615002545/v1_201602060036/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020615002636" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.12.010" "estado" => "S300" "fechaPublicacion" => "2015-06-08" "aid" => "2937" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2015;144:507-13" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 48 "formatos" => array:2 [ "HTML" => 37 "PDF" => 11 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Chronic obstructive pulmonary disease: The golden decade. Implications for the diagnosis, prevention and treatment of chronic obstructive pulmonary disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "507" "paginaFinal" => "513" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad pulmonar obstructiva crónica: la década prodigiosa. Implicaciones para su diagnóstico, prevención y tratamiento" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2337 "Ancho" => 2892 "Tamanyo" => 536581 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Relationship between the gravity of the airflow limitation (FEV<span class="elsevierStyleInf">1</span>) and the level of dyspnoea according to the modified Medical Research Council dyspnoea scale (panel A), exercise capacity determined by the 6-min walking test (panel B), exacerbations in the previous year (panel C), and the health level measured by St. George's Respiratory Questionnaire (panel D) in patients included in the <span class="elsevierStyleItalic">Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints</span>—ECLIPSE—study.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>, forced expiratory volume in one second; mMRC, modified Medical Research Council; SGRQ-C, St. George's Respiratory Questionnaire for COPD patients.</p> <p id="spar0915" class="elsevierStyleSimplePara elsevierViewall">Copied with permission from Agusti et al.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">5</span></a> For further explanation, see text.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandra López-Giraldo, Robert Rodríguez-Roisin, Alvar Agustí" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Alejandra" "apellidos" => "López-Giraldo" ] 1 => array:2 [ "nombre" => "Robert" "apellidos" => "Rodríguez-Roisin" ] 2 => array:2 [ "nombre" => "Alvar" "apellidos" => "Agustí" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314002267" "doi" => "10.1016/j.medcli.2014.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314002267?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002636?idApp=UINPBA00004N" "url" => "/23870206/0000014400000011/v1_201602060036/S2387020615002636/v1_201602060036/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnosis and treatment</span>" "titulo" => "Chronic subdural hematoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "519" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Miguel Gelabert-González, María Rico-Cotelo, Eduardo Arán-Echabe" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Miguel" "apellidos" => "Gelabert-González" "email" => array:2 [ 0 => "miguel.gelabert@usc.es" 1 => "miguel.gelabert.gonzalez@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Rico-Cotelo" ] 2 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Arán-Echabe" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neurocirugía, Departamento de Cirugía, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hematoma subdural crónico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1493 "Ancho" => 1800 "Tamanyo" => 259341 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computerised tomography scans showing different types of internal architecture of the chronic subdural haematoma. (A) Homogeneous (hypodense). (B) Homogeneous (isodense). (C) Homogeneous (hyperdense). (D) Laminate. (E) Separated. (F) Trabecular.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A chronic subdural haematoma (CSDH) is a collection of blood breakdown products in the subdural space. CSDH is frequently diagnosed in hospital emergency departments and constitutes one of the most common disorders treated in neurological surgery departments.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1,2</span></a> Although CSDH is often considered a disease of low severity that can be treated with minimally invasive procedures, having CSDH shortens the life expectancy of the patient.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a> Since CSDH is characteristic of the elderly population, in whom multiple comorbidities coexist, the therapeutic and diagnostic approach involves a range of medical specialities such as neurology, internal medicine, geriatrics, rehabilitation and neurosurgery, among others. Hence, it is very important to detect the haematoma early on, in order to treat it more efficiently in relation to its characteristics.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> We present an update on the treatment of CSDH reviewing its most controversial aspects.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Epidemiology</span><p id="par0010" class="elsevierStylePara elsevierViewall">The incidence of CSDH varies significantly between age groups and increases progressively as the population ages.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> Cousseau et al.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> reported an annual gross-mortality rate of 38 cases/10<span class="elsevierStyleSup">5</span> inhabitants among people of over 80 years of age, falling to 21 cases between 71 and 80 years of age, and to 12, between 61 and 70 years of age. Karibe et al.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> found in their sample of 1445 patients with CSDH that the incidence in the 70–79 years age range was 20.6/10<span class="elsevierStyleSup">5</span> inhabitants per year, rising to 127.1 in patients of over 80 years of age.</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to UN calculations,<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> since 1950 the proportion of persons aged 60 years or older has been constantly increasing from 8% recorded then, to 11% in 2009, and is expected to reach 21% in 2050, representing more than 30% of the population in developed countries. This fast ageing of the population will lead to a significant increase in CSDH in the future.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pathogenesis</span><p id="par0020" class="elsevierStylePara elsevierViewall">CSDH is produced by the slow and progressive accumulation of blood and blood breakdown products in the subdural space. Surprisingly, a real subdural space does not exist, as the dura mater and the arachnoid are intimately glued by a “dural border cell” layer of reduced thickness, with some extracellular collagen, where sparse intercellular connections make it susceptible to separation.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> For CSDH to develop, the combination of one or several predisposing factors is necessary, and the most important factor is brain atrophy, typical of the elderly and alcoholic people, and with trauma as a trigger factor. The origin of the haemorrhage is located in the bridging veins that drain from the brain surface to the dural sinuses, crossing the border cell layer. As a consequence of this small haemorrhage, the border cell layer opens and a healing response is produced mediated by the proliferation of cells and the formation of granulation tissue with collagen fibres, in order to form a capsule to isolate the haemorrhage.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> The haematoma grows as a result of the formation of a local inflammatory reaction, with hyperfibrinolysis, high local levels of tissue plasminogen activator (tPA) and the production of angiogenic factors that promote the neovascularisation of the membrane, producing new haemorrhages due to the fragility of the neo-capillaries.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> The membranes surrounding the CSDH, which appear in the second week, are formed by an inner layer (visceral) and an external layer (parietal) of greater thickness and a greater degree of vascularisation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical manifestations</span><p id="par0025" class="elsevierStylePara elsevierViewall">In 1977, Potter and Fruin<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> coined the term “great imitator” to refer to CSDH, because of the many ways in which it can present and because of the duration of the symptoms, which can often be confused with other more prevalent processes, such as dementia,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> cerebrovascular accidents<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> and Parkinson's disease,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> among others. In our review on 630 surgically treated CSDH cases, the three most frequent presentations were: motor deficit (30%), headache (22%) and cognitive impairment (20.7%), and only 3.5% started with a significant decrease in the level of consciousness.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> The way in which the disease presents itself is related to the age of the patient. In younger patients, the most frequent manifestations are headache and epilepsy seizures, while cognitive impairment is rare; the opposite occurs in the elderly population, in whom cognitive involvement and neurological deficits are more prevalent<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2,4</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Clinical assessment is determined using the Mark Alder scale, which classifies patients in five grades according to the neurological involvement that they present<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Other authors prefer to use the Glasgow Coma Scale. However, in our opinion, this is inadequate due to its limited discriminating value, since in all samples, more than 80% of patients showed a mild consciousness involvement (score 13–15) and fewer than 8%–10% present a score of ≤8.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3,4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Predisposing factors</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Anticoagulation</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients in anticoagulation therapy present up to a 42.5 times higher risk of developing a CSDH, which shows that in those patients with brain atrophy, asymptomatic microhaemorraghes are common, and that anticoagulants will allow the progression of small haemorrhages to become chronic.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> In the majority of the large samples published, the percentage of patients undergoing treatment with these drugs ranges from 20% to 40%.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1,12</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antiaggregation</span><p id="par0035" class="elsevierStylePara elsevierViewall">The risk of developing a CSDH in patients receiving antiaggregation therapy is high; however, it has not been demonstrated that patients undergoing this treatment have a higher incidence of haematomas or poor results after surgery, although there are contradictory opinions on this last issue.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Alcoholism</span><p id="par0040" class="elsevierStylePara elsevierViewall">Alcoholism appears in most of the CSDH sample with an incidence ranging from 5% to 35% of cases which, together with the intake of anticoagulant medications, constitutes one of the two major risk factors.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2,17</span></a> This risk is associated with brain atrophy, coagulation dysfunction and a potential higher incidence of cranial trauma.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Intracranial hypotension</span><p id="par0045" class="elsevierStylePara elsevierViewall">This could be presented in different circumstances, the commonest being a ventricular bypass valve implantation. In a recent publication, Tsen et al.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> analysed 14<span class="elsevierStyleHsp" style=""></span>026 patients of over 65 years old (214 with a valve) who had cranial trauma. They found that incidence of CSDH was 1.5%, while in the control group, with a similar number of patients without cranial trauma, incidence of CSDH was only 0.5% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The use of programmable valves has reduced the CSDH in these patients. Other factors, such as the presence of intracranial arachnoid cysts,<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> cerebrospinal fluid fistulas or vascular malformations, appear in different samples, particularly in younger patients.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12,17</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Radiological diagnosis</span><p id="par0050" class="elsevierStylePara elsevierViewall">A diagnosis of CSDH is made with a computerised tomography scan, where a CSDH usually appears as hypodense lesions (<30 Hounsfield units, HU), located in the convexity of the brain hemispheres, with a substantial displacement of the ventricular system.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> On several occasions, they may be present as isodense formations with the brain parenchyma (30–60<span class="elsevierStyleHsp" style=""></span>HU), or even hyperdense (>60 HU) due to the production of new haemorrhages in the interior of the cavity. Nakaguchi et al.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> described 4 types of CSDHs according to internal structure: homogeneous, laminar, separated or of double density and trabecular types (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The authors have observed that this structure has a close, significant relation with the risk of recurrence, which is 0% for the trabecular structure and 36% for the separated type. A recent review by García-Pallero et al.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> found similar results with rates of recurrence for the trabecular structure and the separated types of 0% and 44.4%, respectively. Despite these findings, the internal architecture of CSDHs has not suggested any modifications to the surgical approach thus far. Magnetic resonance imaging does not provide better value information than that obtained from computerised tomography, and generally presents some issues at the time of performing the study, such as a lack of cooperation from patients with cognitive involvement or the existence of many patients with a cardiac pacemaker, limiting the performance of the study.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Treatment</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Position on anticoagulation</span><p id="par0055" class="elsevierStylePara elsevierViewall">Even when anticoagulation complicates the treatment and the patients receiving this kind of therapy present a longer hospital stay, their prognosis is not influenced by anticoagulant drugs.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> In patients with symptomatic CSDH, the anticoagulant effect needs to be reversed before surgery. In traditional anticoagulants (warfarin, acenocoumarol), the reversal is performed by administering fresh frozen plasma or prothrombin complex, followed by vitamin K. When reversal is not urgent (patients who will be treated conservatively), then reversion can be achieved progressively through the administration of vitamin K alone. The new oral anticoagulants do not have a proven antidote, so a reversion will consist of suspending treatment, since its average life is shorter than that of the traditional anticoagulants, particularly in the case of rivaroxaban. If the last dose was administered up to 2<span class="elsevierStyleHsp" style=""></span>hours previously, then activated charcoal can be used. In dabigatran, a prothrombin complex can be administered if the emergency requires it.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> The European Heart Rhythm Association recommends that, if there is no risk of death, the best antidote for patients with new oral anticoagulants is suspension of treatment and delaying surgery until 24<span class="elsevierStyleHsp" style=""></span>hours after the last dose.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Position on antiaggregant treatment</span><p id="par0060" class="elsevierStylePara elsevierViewall">In these patients, treatment must be suspended to avoid increasing the haematoma. Moreover, if the patient requires urgent intervention, then it will be necessary to reverse the effect with platelet transfusion or by administering desmopressin, even if there are no rigorous studies supporting this intervention.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Adjuvant therapies</span><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment with dexamethasone is highly controversial and has been the subject of several publications in recent years. It is implemented both in the preoperative period as an alternative to surgical treatment, and in the postoperative period. Justification for its use is based on its anti-inflammatory and angiogenic effects, which play an important role in its pathogenesis. One of the first analyses on the subject was the retrospective study performed by Delgado-López et al.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> in a sample of 101 patients (grade 1–2) who were treated exclusively with dexamethasone, showing that 75% of the cases were solved without surgery. However, those patients treated conservatively had a shorter length of stay in hospital. An analysis of the medical literature conducted by Zarkou et al.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a> concludes that the role of glucocorticosteroids in CSDH is not well defined since there are no studies with a high enough level of evidence to confirm their utility. It is not therefore known whether they may be an alternative to surgical evacuation. Berghauser Pont et al.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> analyse five observational publications and confirm the beneficial effect of dexamethasone, which reduces the rate of recurrence and improves the end result, with few complications derived from the use of glucocorticosteroids. In a recent meta-analysis of 34<span class="elsevierStyleHsp" style=""></span>829 patients, Almenawer et al.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> concluded that glucocorticosteroids are not indicated as adjuvant therapy to surgery because they increase morbidity. Possibly, the role of the dexamethasone in CSDH will be defined when the cooperative Chinese-Dutch study is concluded (a double-blind, randomised, placebo-controlled study). This involves 820 patients treated with a burr-hole, without subdural rinsing and with continuous drainage who will receive dexamethasone or a placebo. The results have not been published yet.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The use of anti-epileptic prophylaxis has been analysed in Cochrane,<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> and the authors observe that the incidence of seizures during the preoperative and postoperative periods varies from 2.3%–17% and 1%–23%, respectively. They find no reasons for the use of antiepileptic drugs as a prophylactic measure since these do not impact on the result but only contribute to reduce postoperative seizures.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Patients treated with angiotensin converting enzyme inhibitors (ACEi) for arterial hypertension present a lower rate of recurrences and lower levels of vascular endothelial growth factor (VEGF) than those not treated with ACEi. Hyper-angiogenesis is believed to play important role in the development of CSDH, so ACEi would reduce both the recurrence of haematomas and their progression.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical treatment</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Indications for the surgery</span><p id="par0080" class="elsevierStylePara elsevierViewall">The decision to operate on a CSDH patient depends on two circumstances: their clinical manifestations and the radiographic findings. Although the size of the haematoma and the midline shift play an important role in the decision to operate, there are no indicative values that determine when CSDH should be operated. In general, it is accepted that small haematomas in patients with few symptoms (grades 0–2) may be treated conservatively, while symptomatic haematomas must be operated on regardless of their volume, as surgical evacuation produces an immediate recovery and favourable evolution in more than 80% of patients.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4,12</span></a> We have three surgical techniques: cranial perforation (twist-drill), burr-hole and craniotomy.</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Twist-drill</span><p id="par0085" class="elsevierStylePara elsevierViewall">This consists of a small cranial trepanation, frequently smaller than 10<span class="elsevierStyleHsp" style=""></span>mm, using a hand-driven drill and introducing drainage into the subdural space. The advantage of this is that it can be performed easily with local anaesthesia and, if necessary, in the emergency department or at the patient's bedside. The first reference to this technique comes from Tabaddor and Shulmon<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> in 1977, who verified its superiority compared to craniotomy, which was the standard technique up to that time. It is the recommended procedure for elderly patients, with poor general condition and multiple comorbidities. Recently, a device has been introduced commercially which plugs into the skull, facilitating the implantation of a drain and reducing possible lacerations of the brain that may be produced by the blind introduction of drainage.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> Several studies have demonstrated it is as safe and effective as the burr-hole and subdural drainage.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4,31</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Burr-hole</span><p id="par0090" class="elsevierStylePara elsevierViewall">Proposed by Marwalder<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> in 1981, this involves making one or two burr-holes and rinsing the subdural cavity with physiological saline until the haematoma is completely evacuated, and subsequently implanting a drain for 24–72<span class="elsevierStyleHsp" style=""></span>hours. It is considered the best technique to evacuate most CSDHs and has a low rate of recurrence.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4,12,13</span></a> It can be performed with local anaesthesia and causes no complications in 75% of cases.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2,12</span></a> In the medical literature, the greater efficacy of two burr-holes is under discussion. However, several studies show that there are no differences in recurrences, complications or mortality based on the number of holes made.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> On the contrary, Taussky et al.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> found a longer hospital stay, higher rate of recurrence, and more wound infections in patients treated with only one hole. In a recent meta-analysis Belkhanir and Pickett<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> compared 358 patients treated with only one hole with 355 treated with two perforations and found that both methods are effective and show similar recurrence and complication rates.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Craniotomy</span><p id="par0095" class="elsevierStylePara elsevierViewall">This allows open exposure of the membranes of the haematoma, making it easier to open and evacuate it. However, it is an aggressive technique that must be performed under general anaesthetic and presents high risks in the target population with a CSDH.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4,12</span></a> At present, it is only indicated for cases with recurrent haematomas, with thick membranes and/or septum inside the haematoma and with poor brain re-expansion.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> The review by Weigel et al.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> found that both twist-drill and the burr-hole techniques present better results and lower complication rates than craniotomy.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Another controversial issue is whether or not to perform subdural rinsing. Contradictory experiences have been reported showing both that subdural irrigation does and does not reduce the rate of recurrence.<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">34,35</span></a> Santarious et al.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> and the recent meta-analysis by Almenawer et al.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> concluded that subdural drainage produces a substantial, significant reduction in rates of recurrence.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Local and general anaesthesia</span><p id="par0105" class="elsevierStylePara elsevierViewall">Both types of anaesthesia may be used in the surgical evacuation of the haematoma. Local anaesthesia can be used in more than 70%–75% of patients,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> and the type of anaesthesia is not a decisive factor in the subsequent evolution or the rate of recurrence.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a></p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Postoperative care</span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Mobilisation</span><p id="par0110" class="elsevierStylePara elsevierViewall">Early moving of the patient is the subject of debate. In the review of 4 randomised studies by Alcalá-Cerra et al.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> concluded that there are no differences in the risk of recurrence, reintervention or medical complications in patients who stayed flat in bed by comparison with those whose bed was raised during the postoperative period.</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Administration of fluids</span><p id="par0115" class="elsevierStylePara elsevierViewall">There are controversies regarding the long-term use of intravenous serum treatment to reduce the rate of complications. Janowski and Kunert<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> found that those patients who receive at least 2000<span class="elsevierStyleHsp" style=""></span>ml/day for more than three days have a reduced rate of recurrence.</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Resuming treatment with anticoagulants/antiaggregants</span><p id="par0120" class="elsevierStylePara elsevierViewall">There are no definitive recommendations on when anticoagulant treatment should be resumed and this will depend on the risk of thrombosis in the patient by comparison with the risk of another bleed. In contrast with the existing opinion that the resumption of treatment should be postponed from 7 to 14 days, the American College of Chest Physicians’ practical guidelines recommend the use of compression stockings for patients with both a low and high risk of thrombosis.<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> Moreover, in high-risk patients, it recommends the use of low-molecular-weight heparins starting 12–24<span class="elsevierStyleHsp" style=""></span>hours after intervention, as long as there exists “adequate haemostasis”. There are no studies regarding the optimal time for re-administering antiaggregant treatment to these patients (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results and complications</span><p id="par0125" class="elsevierStylePara elsevierViewall">The recovery of patients after treatment starts with a significant neurological improvement in 75%–85% of the cases, which is more evident in younger patients.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4,12,40</span></a> The medical complications that may appear derive from the personal characteristics of the patients, especially in those with respiratory infections<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> and diabetic or cardiac decompensation,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> among others. The most common surgical complication is recurrence of the haematoma, with incidence ranging from 5% to 25%.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1–4</span></a> The review by Almenawer et al.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> reported this was 11%. Factors associated with this recurrence include: poor clinical condition at admission,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> bilateral haematomas,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> a trabecular structure in the computerised tomography scan<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1,20</span></a> or the presence of intracranial air.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> Other complications include subdural empyema,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> the development of an acute subdural haematoma inside the haematoma cavity, an intraparenchimal haematoma,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> etc.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4,12</span></a> Mortality in the different series ranges from 0% to 10%, and morbidity, from 0% to 25%, depending essentially on two circumstances: the patient's preoperative clinical condition and associated comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2–4,16</span></a></p></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Pathogenesis" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical manifestations" ] 4 => array:3 [ "identificador" => "sec0025" "titulo" => "Predisposing factors" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Anticoagulation" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Antiaggregation" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Alcoholism" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Intracranial hypotension" ] ] ] 5 => array:2 [ "identificador" => "sec0050" "titulo" => "Radiological diagnosis" ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Treatment" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Position on anticoagulation" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Position on antiaggregant treatment" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Adjuvant therapies" ] ] ] 7 => array:3 [ "identificador" => "sec0075" "titulo" => "Surgical treatment" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0080" "titulo" => "Indications for the surgery" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Twist-drill" ] 1 => array:2 [ "identificador" => "sec0090" "titulo" => "Burr-hole" ] 2 => array:2 [ "identificador" => "sec0095" "titulo" => "Craniotomy" ] 3 => array:2 [ "identificador" => "sec0100" "titulo" => "Local and general anaesthesia" ] ] ] 1 => array:3 [ "identificador" => "sec0105" "titulo" => "Postoperative care" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0110" "titulo" => "Mobilisation" ] 1 => array:2 [ "identificador" => "sec0115" "titulo" => "Administration of fluids" ] 2 => array:2 [ "identificador" => "sec0120" "titulo" => "Resuming treatment with anticoagulants/antiaggregants" ] ] ] 2 => array:2 [ "identificador" => "sec0125" "titulo" => "Results and complications" ] ] ] 8 => array:2 [ "identificador" => "sec0130" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-30" "fechaAceptado" => "2015-01-19" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gelabert-González M, Rico-Cotelo M, Arán-Echabe E. Hematoma subdural crónico. Med Clin (Barc). 2015;144:514–519.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1493 "Ancho" => 1800 "Tamanyo" => 259341 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computerised tomography scans showing different types of internal architecture of the chronic subdural haematoma. (A) Homogeneous (hypodense). (B) Homogeneous (isodense). (C) Homogeneous (hyperdense). (D) Laminate. (E) Separated. (F) Trabecular.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">NE: no evidence.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Data expressed in percentages.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gelabert-González et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> (2001) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Delgado-López et al.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> (2009) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Santarious et al.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> (2009) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kolias et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> (2014) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Motor deficit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Headache \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cognitive impairment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Speech disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Epileptic seizure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balance problems \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary incontinence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alterations to vision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab987286.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Symptoms of chronic subdural haematoma in different series.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: Markwalder.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Degree \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Description \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Absence of neurological deficits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Patient alert and oriented. Mild symptoms, such as headache. Absent or mild neurological deficit, such as reflex asymmetry \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Drowsy and disoriented patient with variable neurological deficit \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stuporous patient, but responding to painful stimuli. Severe neurological deficit, such as hemiplegia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Comatose patient without response to painful stimuli, decerebrate or decorticate postures \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab987284.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Markwalder scale.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CSDH: chronic subdural haematoma; IV: intravenous.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Item \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treatment with dexamethasone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In a patient with a good clinical grade (0–2), treatment with dexamethasone could solve 75% of CSDH cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Delgado-López et al.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>; Berghauser Pont et al.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">One or two burr-holes or alternatively cranial perforation (twist-drill) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Singla et al.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>; Almenawer et al.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Irrigation of the subdural space \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Although contradictory studies exist, intraoperative irrigation of the subdural space reduces the rate of recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liu et al.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type of anaesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preferably use local anaesthesia. There are no differences in either results or complications implementing either technique \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gelabert-González et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drainage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The use of a closed subdural drain implies a lower rate of recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kolias et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a>; Almenawer et al.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Raise the head of the bed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No studies demonstrate that resting after surgery reduces the rate of recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alcalá-Cerra et al.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a>Almenawer et al.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV fluids during postoperative period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The administration of at least 2000<span class="elsevierStyleHsp" style=""></span>ml/day for at least 3 days may reduce the rate of recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Janowski and Kunert<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reversal of antiaggregant treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7-day suspension before surgery is sufficient. In an emergency, use a transfusion of platelets or desmopressin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Le Roux et al.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resumption of antiaggregant treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">There are no recommendations. In general, reintroducing therapy a week after surgery is suggested \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chari et al.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reversal of anticoagulants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Quick reversal of anticoagulation using prothrombin complex and vitamin K \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Le Roux et al.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resumption of anticoagulants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">After 72<span class="elsevierStyleHsp" style=""></span>hours in high risk patientsAssess each case individually \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rust et al.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antiepileptic medication. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">There is no reason for using primary prophylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ratilal et al.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab987285.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Recommendations for the treatment of chronic subdural haematoma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0205" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hematomas subdurales crónicos. Arquitectura interna del hematoma como predictor de recidiva" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. García-Pallero" 1 => "P. Pulido-Rivas" 2 => "J.M. Pascual-Garvi" 3 => "R.G. Sola" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2014" "volumen" => "59" "paginaInicial" => "294" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25245873" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0210" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hematoma subdural crónico en el paciente Mayr de 80 años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Gelabert-González" 1 => "J.M. Fernández-Villa" 2 => "E. López-García" 3 => "A. García-Allut" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurocirugía (Astur)" "fecha" => "2001" "volumen" => "12" "paginaInicial" => "325" "paginaFinal" => "330" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0215" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural hematoma in the elderly: not a benign disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.B. Miranda" 1 => "E. Braxton" 2 => "J. Hobbs" 3 => "M.R. Quigley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2010.8.JNS10298" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2011" "volumen" => "114" "paginaInicial" => "72" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20868215" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0220" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural hematoma: modern management and emerging therapies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.G. Kolias" 1 => "A. Chari" 2 => "T. Santarius" 3 => "P.J. Hutchinson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrneurol.2014.163" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Neurol" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "570" "paginaFinal" => "578" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25224156" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0225" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hematoma subdural crónico y subagudo. Estudio epidemiológico en una población cautiva" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Cousseau" 1 => "G. Echevarría" 2 => "M. Gaspari" 3 => "S.E. Gonorazky" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2001" "volumen" => "32" "paginaInicial" => "821" "paginaFinal" => "824" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11424031" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0230" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Epidemiology of chronic subdural hematoma] Japanese" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Karibe" 1 => "M. Kameyama" 2 => "M. Kawase" 3 => "T. Hirano" 4 => "T. Kawaguchi" 5 => "T. Tominaga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "No Shinkei Geka" "fecha" => "2011" "volumen" => "39" "paginaInicial" => "1149" "paginaFinal" => "1153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22128269" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0235" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Department of Economic and Social Affairs, Population Division. World Population Ageing 2013. ST/ESA/SER.A/348" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "United Nations" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "United Nations" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0240" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural hematoma – The «great imitator»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.F. Potter" 1 => "A.H. Fruin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Geriatrics" "fecha" => "1977" "volumen" => "32" "paginaInicial" => "61" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/863266" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0245" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive decline as an important sign for an operable cause of dementia: chronic subdural haematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.M. Schebesch" 1 => "C. Woertgen" 2 => "R. Rothoerl" 3 => "O.W. Ullrich" 4 => "A.T. Brawanski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-1004582" "Revista" => array:6 [ "tituloSerie" => "Zentralbl Neurochir" "fecha" => "2008" "volumen" => "69" "paginaInicial" => "61" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18444216" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0250" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Huge chronic subdural hematoma mimicking cerebral infarction on computed tomography – Case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Shimizu" 1 => "T. Ozawa" 2 => "K. Irikura" 3 => "T. Sagiuchi" 4 => "S. Kan" 5 => "K. Fujii" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurol Med Chir (Tokyo)" "fecha" => "2002" "volumen" => "42" "paginaInicial" => "380" "paginaFinal" => "382" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0255" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parkinsonims secondary to subdural haematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Gelabert-González" 1 => "R. Serramito-García" 2 => "E. Arán-Echabe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10143-012-0386-1" "Revista" => array:6 [ "tituloSerie" => "Neurosurg Rev" "fecha" => "2012" "volumen" => "35" "paginaInicial" => "457" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22527627" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0260" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural hematoma treated by burr holes and closed drainage system: a review of 630 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Gelabert-González" 1 => "E. López-García" 2 => "J.M. Fernández-Villa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Princ Pract" "fecha" => "2001" "volumen" => "10" "paginaInicial" => "41" "paginaFinal" => "47" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0265" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural hematomas: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.M. Markwalder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg" "fecha" => "1981" "volumen" => "54" "paginaInicial" => "547" "paginaFinal" => "549" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0270" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Rust" 1 => "N. Kiemer" 2 => "A. Erasmus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jocn.2004.12.013" "Revista" => array:6 [ "tituloSerie" => "J Clin Neurosci" "fecha" => "2006" "volumen" => "13" "paginaInicial" => "823" "paginaFinal" => "827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16997707" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0275" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dexametathasone treatment in chronic subdural haematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.D. Delgado-López" 1 => "V. Martín-Velasco" 2 => "J.M. Castilla-Díez" 3 => "A. Rodríguez-Salazar" 4 => "A.M. Galacho-Harriero" 5 => "O. Fernández-Arconada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurocirugia (Astur)" "fecha" => "2009" "volumen" => "20" "paginaInicial" => "346" "paginaFinal" => "359" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0280" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Santarious" 1 => "P.J. Kirpatrick" 2 => "D. Ganesan" 3 => "H.L. Chia" 4 => "I. Jalloh" 5 => "P. Smielewski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61115-6" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "1067" "paginaFinal" => "1073" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19782872" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0285" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent changes in risk factors of chronic subdural hematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y.W. Sim" 1 => "K.S. Min" 2 => "M.S. Lee" 3 => "Y.G. Kim" 4 => "D.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3340/jkns.2012.52.3.234" "Revista" => array:6 [ "tituloSerie" => "J Korean Neurosurg Soc" "fecha" => "2012" "volumen" => "52" "paginaInicial" => "234" "paginaFinal" => "239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23115667" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0290" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for chronic subdural hematoma after a minor head injury in the elderly: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.H. Tseng" 1 => "M.Y. Tseng" 2 => "A.J. Liu" 3 => "W.H. Lin" 4 => "H.Y. Hu" 5 => "S.H. Hsiao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2014/218646" "Revista" => array:5 [ "tituloSerie" => "Biomed Res Int" "fecha" => "2014" "volumen" => "2014" "paginaInicial" => "218646" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25295251" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0295" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Gelabert-González" 1 => "D. Castro-Bouzas" 2 => "A. Arcos-Algaba" 3 => "J.M. Santín-Amo" 4 => "L. Díaz-Cabanas" 5 => "R. Serramito-García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurocirugia (Astur)" "fecha" => "2010" "volumen" => "21" "paginaInicial" => "222" "paginaFinal" => "227" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0300" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Nakaguchi" 1 => "T. Tanishima" 2 => "N. Yoshimasu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.2001.95.2.0256" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2001" "volumen" => "95" "paginaInicial" => "256" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11780895" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0305" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Race against the clock: overcoming challenges in the management of anticoagulant-associated intracerebral hemorrhage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Le Roux" 1 => "C.V. Pollack" 2 => "M. Milan" 3 => "A. Schaefer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2014.6.GKS141282" "Revista" => array:7 [ "tituloSerie" => "J Neurosurg" "fecha" => "2014" "volumen" => "121" "numero" => "Suppl" "paginaInicial" => "1" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25434932" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0310" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommencement of anticoagulation in chronic subdural haematoma: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Chari" 1 => "T. Clemente Morgado" 2 => "D. Rigamonti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02688697.2013.812184" "Revista" => array:6 [ "tituloSerie" => "Br J Neurosurg" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "2" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23834661" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0315" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Heidbuchel" 1 => "P. Verhamme" 2 => "M. Alings" 3 => "M. Antz" 4 => "W. Hacke" 5 => "J. Oldgren" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eut083" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "625" "paginaFinal" => "651" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23625942" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0320" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of corticosteroids in the management of chronic subdural hematomas: a critically appraised topic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Zarkou" 1 => "M. Aguilar" 2 => "N. Patel" 3 => "K. Wellik" 4 => "D. Wingerchuk" 5 => "B. Damaerschalk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/NRL.0b013e3181b65558" "Revista" => array:6 [ "tituloSerie" => "Neurologist" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "299" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19741442" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0325" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of corticosteroids in the management of chronic subdural hematoma: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.M. Berghauser Pont" 1 => "C.M. Dirven" 2 => "D.W. Dippel" 3 => "B.H. Verweij" 4 => "R. Dammers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-1331.2012.03768.x" "Revista" => array:6 [ "tituloSerie" => "Eur J Neurol" "fecha" => "2012" "volumen" => "19" "paginaInicial" => "1397" "paginaFinal" => "1403" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22642223" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0330" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural hematoma management: a systematic review and meta-analysis of 34829 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Almenawer" 1 => "C. Farrokhyar" 2 => "C. Hong" 3 => "W. Alhazzani" 4 => "B. Manoranjan" 5 => "B. Yarascavitch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0000000000000255" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2014" "volumen" => "259" "paginaInicial" => "449" "paginaFinal" => "457" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24096761" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0335" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy of dexamethasone on reduction in the reoperation rate of chronic subdural hematoma – The DRESH study: straightforward study protocol for a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Emich" 1 => "B. Richling" 2 => "M.R. McCoy" 3 => "R. Al-Schameri" 4 => "F. Ling" 5 => "L. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1745-6215-15-6" "Revista" => array:5 [ "tituloSerie" => "Trials" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24393328" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0340" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anticonvulsivants for preventing seizures in patients with chronic subdural haematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.O. Ratilal" 1 => "L. Pappamikail" 2 => "J. Costa" 3 => "C. Sampaio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD004893.pub3" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "CD004893" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23744552" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0345" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiotensin converting enzyme inhibition for arterial hypertension reduces the risk of recurrence in patients with chronic subdural hematoma possibly by an angiogenic mechanism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Weigel" 1 => "A. Hoheenstein" 2 => "L. Schlickum" 3 => "C. Weiss" 4 => "L. Schilling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1227/01.NEU.0000298907.56012.E8" "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2007" "volumen" => "61" "paginaInicial" => "788" "paginaFinal" => "792" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17986940" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0350" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Tabbador" 1 => "K. Shulmon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.1977.46.2.0220" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "1977" "volumen" => "46" "paginaInicial" => "220" "paginaFinal" => "226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/833639" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0355" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subdural evacuating port system (SEPS) – minimally invasive approach to the management of chronic/subacute subdural hematomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Singla" 1 => "W.P. Jacobsen" 2 => "I.R. Yusupov" 3 => "D.A. Carter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clineuro.2012.06.005" "Revista" => array:6 [ "tituloSerie" => "Clin Neurol Neurosurg" "fecha" => "2013" "volumen" => "115" "paginaInicial" => "425" "paginaFinal" => "431" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22763191" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0360" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "One vs. two burr hole craniostomy in surgical treatment of chronic subdural hematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.J. Han" 1 => "C.W. Park" 2 => "E.Y. Kim" 3 => "C.J. Yoo" 4 => "Y.B. Kim" 5 => "W.K. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3340/jkns.2009.46.2.87" "Revista" => array:6 [ "tituloSerie" => "J Korean Neurosurg Soc" "fecha" => "2009" "volumen" => "46" "paginaInicial" => "87" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19763208" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0365" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Taussky" 1 => "J. Fandino" 2 => "H. Landolt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/02688690701818885" "Revista" => array:6 [ "tituloSerie" => "Br J Neurosurg" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "279" "paginaFinal" => "282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18348026" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0370" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "One versus double burr holes for treating chronic subdural hematoma meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Belkhanir" 1 => "G. Pickett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Neurol Sci" "fecha" => "2013" "volumen" => "40" "paginaInicial" => "56" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23250128" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0375" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Liu" 1 => "N.A. Bakker" 2 => "R.J. Groen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/2014.5.JNS132715" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2014" "volumen" => "121" "paginaInicial" => "665" "paginaFinal" => "673" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24995782" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0380" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of contemporary surgery for chronic subdural haematoma: evidence based review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Weigel" 1 => "P. Schmiedek" 2 => "J.K. Krauss" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "2003" "volumen" => "74" "paginaInicial" => "937" "paginaFinal" => "943" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12810784" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0385" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posicionamiento postoperatorio de la cabecera tras drenaje de hematomas subdurales crónicos por trepanación: revisión sistemática y metaanálisis de estudios controlados aleatorizados" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Alcalá-Cerra" 1 => "L.R. Moscote-Salazar" 2 => "A. Paternina-Caicedo" 3 => "J.J. Gutiérrez-Paternina" 4 => "L.M. Niño-Hernández" 5 => "R. Sabogal-Barrios" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurocirugia (Astur)" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "99" "paginaFinal" => "107" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0390" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous fluid administration may improve post-operative course of patients with chronic subdural hematoma: a retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Janowski" 1 => "P. Kunert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0035634" "Revista" => array:5 [ "tituloSerie" => "PloS One" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "e35634" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22532865" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0395" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Executive summary: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American College of Chest Physicians" "etal" => false "autores" => array:5 [ 0 => "J. Hirsh" 1 => "G. Guyatt" 2 => "G.W. Albers" 3 => "R. Harrington" 4 => "H.J. Schünemann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-0693" "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "2008" "volumen" => "133" "numero" => "6 Suppl" "paginaInicial" => "71S" "paginaFinal" => "109S" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18574259" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0400" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hematoma subdural crónico en pacientes jóvenes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Gelabert-González" 1 => "C. Frieiro-Dantas" 2 => "R. Serramito-García" 3 => "L. Díaz-Cabanas" 4 => "E. Aran-Echabe" 5 => "M. Rico-Cotelo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurocirugia (Astur)" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "63" "paginaFinal" => "69" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014400000011/v1_201602060036/S2387020615002508/v1_201602060036/en/main.assets" "Apartado" => array:4 [ "identificador" => "44144" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Diagnosis and treatment" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014400000011/v1_201602060036/S2387020615002508/v1_201602060036/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615002508?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 4 | 2 | 6 |
| 2017 October | 7 | 4 | 11 |
| 2017 September | 13 | 1 | 14 |
| 2017 August | 8 | 2 | 10 |
| 2017 July | 14 | 2 | 16 |
| 2017 June | 12 | 2 | 14 |
| 2017 May | 4 | 0 | 4 |
