Can Low-Dose Radiation Therapy Aid in Chronic Subdural Hematoma Management? A Historical Review.

Purpose: Neurosurgical management of chronic subdural hematoma (cSDH) is complicated by high recurrence rates, which can be especially challenging in the elderly and patients with significant comorbidities. Minimally invasive treatment with middle meningeal artery embolization is increasingly used adjunctively and as a primary treatment for those who are poor surgical candidates, but middle meningeal artery embolization carries its own risks and limitations. Identifying a noninvasive treatment that could similarly be used as an adjunctive or alternative therapy for cSDH may further mitigate morbidity and mortality associated with repeated surgical intervention. Methods and Materials: This review assesses the potential role of low-dose radiation therapy (LD-RT) in cSDH management by examining the condition's pathophysiology, current treatment options, and the biological and clinical rationale for LD-RT. Results: The anti-inflammatory effects of LD-RT could theoretically modulate the cycle of inflammation, neomembrane vascularization, and microhemorrhage that characterizes the pathophysiology of recurrent cSDH. Historical case series from the mid-20th century reported clinical improvement in cSDH patients treated with low doses of x-ray therapy, but these findings require validation with modern scientific approaches, including preclinical rodent models and prospective pilot clinical trials employing contemporary neuroimaging endpoints to quantify hematoma resolution. Conclusions: As an anti-inflammatory treatment, LD-RT could theoretically be a noninvasive tool for managing cSDH, either as an adjunct to surgery or for patients who are poor surgical candidates. Therefore, it may be time to re-explore this modality to evaluate if LD-RT has any potential role in aiding cSDH management.