Subdural hematoma surgery

Subdural Hematoma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Surgery is the first-line treatment option for patients with subdural hematoma and include craniotomy, burr hole trephination, decompressive craniectomy.

Indications

• Surgery is the first-line treatment option for patients with subdural hematoma. Surgery is usually reserved for patients with either:
  • In acute SDH:
    • Advanced age
    • Clot thickness >10 mm
    • Midline shift >5 mm
    • ≥2 decrease in GCS
    • Abnormal pupill
  • In chronic SDH
    • Cognitive impairment
    • Progressive neurologic symptoms
    • Clot thickness ≥10 mm
    • Midline shift ≥5 mm

Surgery

• Surgery is the mainstay of treatment for subdural hematoma:
  • Craniotomy
  • Burr hole trephination
  • Decompressive craniectomy