Chronic subdural hematoma (CSDH) is characterized by an encapsulated collection of old blood. Although CSDH has become the most frequent pathologic entity in daily neurosurgical practice, there are some unresolved research questions. In particular, the causes and recurrent risk factors of CSDH remain as an object of debate. The split of the dural border layer forms a few tiers of dural border cells over the arachnoid layer. Tissue plasminogen activator plays an important role as a key factor of defective coagulation. Historically, CSDH has often been treated via burr hole craniostomy using a closed drainage system. Several different operative strategies and peri-operative strategies such as the addition of burr holes, addition of cavity irrigation, position of drain, or postural position, have been described previously. Although the direction of the drainage tube, residual air, low intensity of T1-weighted images on MRI, and niveau formation have been reported as risk factors for recurrence, antiplatelet or anticoagulant drug use has not yet been verified as a risk factor. Recently, pharmaceutical strategies, including atorvastatin, significantly improved the neurological function in CSDH patients. Many case series, without randomization, have been reported; and given its promising result, several randomized clinical trials using pharmaceutical as well as operative and perioperative strategies were initiated to obtain sufficient data. In contrast, relatively fewer basic studies have achieved clinical applications in CSDH, although it is one of the most common clinical entities. Further scientific basic research may be essential for achieving a novel treatment strategy for CSDH.

慢性硬膜下血肿 (CSDH) 的特征是旧血液的包裹性集合。尽管 CSDH 已成为日常神经外科实践中最常见的病理实体，但仍有一些未解决的研究问题。特别是，CSDH 的病因和复发风险因素仍然是争论的对象。硬脑膜边界层的分裂在蛛网膜层上形成了几层硬脑膜边界细胞。组织纤溶酶原激活剂作为凝血功能障碍的关键因素起着重要作用。从历史上看，CSDH 经常通过使用封闭引流系统的钻孔开颅术进行治疗。之前已经描述了几种不同的手术策略和围手术期策略，例如增加钻孔、增加腔冲洗、引流位置或体位位置。虽然引流管的方向、残留空气、MRI 上 T1 加权图像的低强度和 niveau 形成已被报告为复发的危险因素，但尚未证实使用抗血小板或抗凝药物是危险因素。最近，包括阿托伐他汀在内的药物策略显着改善了 CSDH 患者的神经功能。已经报告了许多未经随机化的病例系列；鉴于其有希望的结果，启动了几项使用药物以及手术和围手术期策略的随机临床试验以获得足够的数据。相比之下，虽然 CSDH 是最常见的临床实体之一，但在 CSDH 中实现临床应用的基础研究相对较少。