When is surgery treatment indicated for subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

In a series of patients with acute traumatic subdural hematoma initially treated conservatively, Wong found that if patients presented with a GCS score of 15 or lower and a midline shift greater than 5 mm, their condition usually would deteriorate and they would require surgery. [34] In another series reported by Matthew et al, all patients initially treated nonoperatively who subsequently required surgery presented with subdural hematomas that were at least 10 mm thick on their initial CT scan.

Surgery has been advocated when a subdural hematoma is associated with compressed or effaced basilar cisterns. In one large series of patients with severe head injuries, the mortality rates were 77%, 39%, and 22% for patients with effaced, compressed, or normal cisterns, respectively. [35]

A meta-analysis comparing the efficacy of various methods of chronic subdural hematoma evacuation supported twist drill craniostomy drainage at the bedside for patients who are high-risk surgical candidates with nonseptated chronic subdural hematomas. [36] Chronic subdural hematomas with significant membrane formation were most effectively treated with craniotomy.

A decision analysis performed by Lega et al revealed that bur-hole craniostomy was the most efficient form of surgical drainage for uncomplicated chronic subdural hematomas. [37] Intraoperative subdural irrigation or postoperative subdural drainage did not significantly affect treatment outcomes.

For more information, see the Medscape Reference article Subdural Hematoma Surgery.


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