The Chronic Subdural Hematoma Surgery Overview
The Chronic Subdural Hematoma Surgery Overview A chronic subdural hematoma (CSDH) is a collection of blood that develops between the dura mater and the arachnoid layer of the brain, typically resulting from minor head trauma or brain atrophy in older adults. While some hematomas resolve spontaneously, many persist or enlarge over time, necessitating surgical intervention to alleviate pressure on the brain and prevent further neurological deterioration. Surgery remains the primary treatment option for symptomatic chronic subdural hematomas, with the goal of removing the accumulated blood and reducing intracranial pressure.
The most common surgical approach is burr hole craniostomy. This minimally invasive procedure involves drilling one or two small holes into the skull overlying the hematoma. Once the holes are made, the neurosurgeon inserts a catheter or suction device to drain the liquefied blood. The procedure is typically performed under local anesthesia with sedation, making it suitable for elderly and medically fragile patients. After drainage, the surgeon may irrigate the subdural space to remove residual blood clots and reduce the likelihood of recurrence. The bone flap often remains unremoved, and the small burr holes are closed, allowing the patient to recover relatively quickly with a low complication rate.
In some cases, especially when the hematoma is thick or recurrent, a more extensive procedure called a craniotomy may be performed. This involves temporarily removing a larger section of the skull to allow for thorough evacuation of the hematoma and inspection of the subdural space. Craniotomy provides better visualization and access for cleaning out organized or complex clots, but it is more invasive and associated with a longer recovery period.
A key consideration during surgery is the management of potential bleeding sources, such as torn bridging veins. Surgeons carefully control bleeding to prevent further accumulation of blood and minimize complications. Postoperative care includes monitoring for signs of rebleeding, infection, or neurological deterioration. Patients are typically observed in a hospital setting, with follow-up imaging—usually a CT scan—to ensure complete removal of the hematoma and to detect any early signs of recurrence.
Recurrence of a chronic subdural hematoma is not uncommon, occurring in approximately 10-20% of cases. Factors influencing recurrence include age, use of anticoagulants, the size of the original hematoma, and the presence of brain atrophy. To reduce the risk, some surgeons may place a drain during surgery to facilitate continuous evacuation and monitor its output closely.
Overall, surgery for chronic subdural hematoma is a highly effective procedure with a high success rate in restoring neurological function and preventing further deterioration. Advances in minimally invasive techniques and postoperative management continue to improve outcomes and reduce complications, making surgical intervention a vital option for symptomatic patients.
