J Korean Neurosurg Soc.  2019 Mar;62(2):144-152. 10.3340/jkns.2018.0156.

How to Treat Chronic Subdural Hematoma? Past and Now

• Lee KS

• KMID: 2441558
• DOI: http://doi.org/10.3340/jkns.2018.0156

Abstract

Treatment of chronic subdural hematoma (CSDH) is relatively straightforward, however, there is still some debate regarding the best strategy for treatment. The most practical recommendations of up to date were identified by a review of literature. The author reviewed the literature on CSDH management from the past to now to identify the best methods. Till 1970s, craniotomy was the most commonly used method. Burr hole (BH) became the most preferred method from 1980s. In 1977, twist drill (TD) craniostomy was introduced. Closed system drainage after a BH or a TD became the most frequently used surgical method. Although nonsurgical treatment is often successful, trephination has more advantages, such as rapid resolution of the symptoms and short period of hospitalization. Nonsurgical treatment is possible in asymptomatic patients with a small CSDH. For the symptomatic patients with CSDH, trephination is the treatment of choice, either by BH or TD. In gray zone between surgery and medical treatment, shared decision making can be an ideal approach. For the recurrent CSDHs, repeated trephination is still effective for patients with a low risk of recurrence. If the risk of recurrence is high, additional management would be helpful. For the refractory CSDHs, it is necessary to obliterate the subdural space.

Keyword

Hematoma, Subdural, Chronic; Craniotomy; Trephining; Conservative treatment; Recurrence; Craniocerebral trauma

MeSH Terms

Craniocerebral Trauma
Craniotomy
Decision Making
Drainage
Hematoma, Subdural, Chronic*
Hospitalization
Humans
Methods
Recurrence
Subdural Space
Trephining

Figure

• 

  Fig. 1. Algorithm for practical management of chronic subdural hematoma. EMMA : embolization of middle meningeal artery, SDSO : subdural space obliteration, SDP : subduroperitoneal.

Reference

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