What are the BTF-CNS guidelines for the surgical management of acute subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Surgery for emergent decompression has been advocated if the acute subdural hematoma is associated with a midline shift greater than or equal to 5 mm. Surgery also has been recommended for acute subdural hematomas exceeding 1 cm in thickness. These indications have been incorporated into the Guidelines for the Surgical Management of Acute Subdural Hematomas proposed by a joint venture between the Brain Trauma Foundation and the Congress of Neurological Surgeons, released in 2006. [33]

These guidelines also call for emergent decompression in a comatose patient with an acute subdural hematoma less than 1 cm in thickness causing a midline shift of less than 5 mm if any of the following criteria are met:

  • The GCS score decreases by 2 or more points between the time of injury and hospital evaluation

  • The patient presents with fixed and dilated pupils

  • The intracranial pressure (ICP) exceeds 20 mm Hg

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