Average length of stay, 30 day readmission, and rate of return to or were documented. Csdh in neurosurgical services, the gold standard manage. There is lack of uniformity in the treatment of csdh amongst surgeons in terms of various treatment strategies. Chronic subdural hematoma csdh is one of the most common neurosurgical conditions. Introduction with increase in the aging population, many diseases have become more prevalent. To compare the efficacy and safety of multiple treatment modalities for the management of chronic subdural hematoma csdh patients.
Management of chronic subdural hematoma with the subdural. Pdf to compare the efficacy and safety of multiple treatment modalities for the management of chronic subdural hematoma csdh patients. Subdural hematoma symptoms, diagnosis and treatment bmj. Nov 05, 2015 the role of corticosteroids in the management of chronic subdural hematoma csdh remains a matter of debate. Management of chronic subdural hematoma in brazil scielo.
Chronic subdural hematoma csdh is a common neurosurgical pathology associated with prior traumatic brain injury tbi and older age that. Initial management of patients with concern for altered mental status with or without trauma starts with emergency neurological life support enls guidelines, with a focus on maintaining icp 60 mmhg, map 80110 mmhg, and pao 2 60 mmhg, followed by rapid sequenc. Chronic subdural hematoma csdh is a common condition after head trauma. Management of a patient with subdural hematoma includes resuscitation followed by control of the bleeding. Chronic subdural hematoma csdh is one of the most common neurosurgical diagnoses in adults. A chronic subdural hematoma sdh is an old clot of blood on the surface of the brain beneath its outer covering. Management either consisted of burr hole drainage, subdural evacuation port system, or craniotomy. The common manifestations are altered mental state and focal neurological deficit. Spontaneous recurrent chronic subdural hematoma in a. For the management of craniotomy or burr hole for sdh or edh, see chapter on craniotomy chapter 101.
Chronic subdural hematoma as a complication of cerebrospinal. Risk factors for need of reoperation in bilateral chronic. A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. Subdural evacuating port system seps minimally invasive approach to the management of chronic subacute subdural hematomas clin neurol neurosurg, 115 4 20, pp. Jacobs is trans ferred to the local trauma center for definitive management of her head bleed. Subdural hematoma an overview sciencedirect topics. A recent research found that the risk of developing subdural hematoma can be up to 40 times more in individuals on anticoagulants than individuals who are not. Sep 10, 2011 chronic subdural hematoma csdh is an increasingly common neurological disease process. Assessing and managing patients with chronic subdural hematoma. It can often be successfully treated surgically by inserting a bur hole and draining the liquefied hematoma. Incidence and prevalence of subdural hematomas have been increasing lately, with this increase being more prominent in older individuals that could reach 80 cases per 100,000 personyears.
Originalarticle management of chronic subdural hematoma. A subdural haematoma sdh is a collection of blood that forms in the subdural space, the space between the dura mater and the arachnoid mater fig. The initial surgical management of chronic subdural he matoma csdh is still controversial, and a standard ther. Causes, clinical presentation, management, and outcomes of. A subtype of csdh is bilateral chronic subdural haematoma bcsdh which represents 2025% of patients with csdh and has a higher recurrence rate. We provide an overview of the epidemiology and pathophysiology of csdh and discuss several controversial management issues, including the timing of postoperative resumption of. Since the introduction of adjustablepressure valves, successful management of shuntrelated csdhs has been reported 34, 35. It is also one of the oldest documented neurosurgical conditions. Diagnosis and management overview in primary care setting amy s. Evidencebased treatment of chronic subdural hematoma.
These liquefied clots most often occur in patients age 60 and older who have brain atrophy, a shrinking or wasting away of brain tissue due to age or disease. The management of a patient with a subdural hematoma will depend greatly on the extent of the bleed, its location, and the overall clinical status. A subscription is required to access all the content in best practice. Although medical treatment was used by some authors and found some positive results, it is not accepted by many authors. It was thought that its development was continuous from acute to subacute and then to chronic subdural hematoma. Subdural hematomas recur at a rate of 2% to 37% after surgical evacuation. Emergency management of subdural hematoma 1509 diagnosis signs and symptoms chronic subdural hematoma can be quite challenging to diagnose, especially due to its high incidence among elderly, with the vague presentation of only decreased physical activity. Jan 16, 2010 the main conclusion of thomas santarius and colleagues well done study sept 26, p 10671that morbidity from chronic subdural haematoma is lower if a drain is placed postoperativelywill probably change the management of this condition around the world. There is no clear consensus on how bcsdh should be treated regarding upfront unilateral or bilateral evacuation of both haematomas.
Chronic subdural hematoma csdh is expected to double by 2030. Chronic subdural haematoma in the elderly postgraduate. Supplemental digital content is available in the text. An sdh can occur spontaneously or result from a head injury or various other pathologies. The management and outcome for patients with chronic subdural. Aggressive reversal of coagulopathy should be accomplished in most patients with a subdural hematoma who are taking anticoagulants. We provide an overview of the epidemiology and pathophysiology of csdh and discuss several controversial management issues, including the timing of postoperative resumption of anticoagulant medications, the effectiveness of antiepileptic prophylaxis, protocols for mobilization. Choose one of the access methods below or take a look at our subscribe or free trial options. Frazier read before the joint meeting of the philadelphia academy of surgery and the new york surgical society, in philadelphia, february 14, 1934. The squid trial for the embolization of the middle meningeal. Chronic subdural medical management neurosurgery clinics. The patients, aged 5 to 84 years, were graded retrospectively according to the bender scale.
Spontaneous recurrent chronic subdural hematoma in a young woman. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of hospital admission, often as dementia. Medical management of subdural hematomas curr treat options neurol. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. People with chronic subdural hematomas usually have the best prognosis, especially if they have few or no symptoms and remained awake and alert after the head injury. In the present study, we analyzed the need of craniotomy in 114 surgically managed cases of csdh, the indications for it, and the surgical outcome. Subdural hematoma is diagnosed using ct or mri imaging.
Chronic subdural hematoma csdh is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable prognosis. The management and outcome for patients with chronic. Middle meningeal artery embolization for the management of. Chronic subdural hematoma, occurs most commonly after minor head injury. One hundred and thirtythree patients with chronic subdural hematoma were treated surgically between 1943 and 1980. Direct url citations appear in the printed text and are provided in the html and pdf versions of this article on the. Considering various features of csdh and the procedure itself, a sitting position may retain the best characteristics of classic positioning, while offering additional comfort for both the patient and the surgeon. In patients undergoing craniostomy for the evacuation of chronic subdural haematoma, does the use of two burrholes compared. The conservative and pharmacological management of chronic.
This population is of special importance due to the continuous increase in chronic oral anticoagulants use. Neurosurgical and perioperative management of chronic. Subdural hematoma sdh is characterized by a collection of blood or fluid blood products in the space between the dura mater and arachnoid or pial layer in the brain. Medical and surgical management of chronic subdural hematomas. Removing tripping hazards from your home especially if you are elderly. Bridging vessels that cross this space channel blood from the brain to. Older adults have an increased risk of developing another bleed hemorrhage after recovering from a chronic subdural hematoma. Csdh is often regarded as a benign, easily treatable disorder, but recurrence rates vary between 10 and 15% and mortality can be as high as 27%. Endoscopic management of chronic subdural hematoma. Surgical options include percutaneous twistdrill craniostomy tdc, operative burrhole evacuation, and craniotomy. Chronic subdural haematoma csdh is a common neurosurgical condition with an incidence of 8 to 14 per 100,000 personyears. Dural biopsy should be taken, especially in recurrence and thick outer membrane. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. Mri in diagnosis of subdural hematoma, treatment of subdural hematoma.
Chronic subdural hematoma sdh in the elderly population is a common problem encountered in neurosurgical practice. Endoscopic treatment was also recently found to be useful. Furthermore, it has also been shown that antiplatelet therapy alone and in combination with anticoagulant therapy also increases the risk for csdh 11, 12. Small, asymptomatic subdural hematomas can be managed conservatively with serial ct scans of the head to assess for any interval change in hemorrhage size. Treatment and outcome of chronic subdural hematoma in sub. Subdural evacuating port system sepsminimally invasive approach to the management of chronic subacute subdural hematomas. Awake surgery in sitting position for chronic subdural. In sdh, blood accumulates in the space between the dural and arachnoid membranes surrounding the brain. Considering various features of csdh and the procedure itself, a sitting position may retain the best characteristics of classic positioning, while offering additional. A history of direct trauma to the head is absent in up to half the cases. Subdural hematoma symptoms, diagnosis and treatment.
Jun 01, 2020 stem study is a pivotal, international, multicenter, prospective, randomized 1. About chronic subdural hematomas general information. Generally, males have a higher incidence and prevalence of subdural hematomas than females, and it is estimated. Csdh in neurosurgical services, the gold standard manage ment of this condition still remains. Treatment options vary from medical therapy and bedside procedures to major operative techniques. Evacuation of chronic and subacute subdural hematoma via. Included studies were assessed for the risk of bias. The surgical management of chronic subdural hematoma. Subdural hematoma chronic subdural hematoma recurrent subdural hematoma.
Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. Results from 2011 to 2014, 3 patients were treated with burr hole drainage, 56 patients were treated with craniotomy, and 5 patients were treated with a subdural evacuating port system seps. Evolving management of symptomatic chronic subdural hematoma. Standard surgical treatment has recurrence rates reported between 4 and 26%. The role of medical treatment in chronic subdural hematoma. May 30, 2017 chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. Common risk factors for csdh are falls, alcohol abuse, anticoagulant therapy, advanced age and brain atrophy. Craniotomy and twist drill craniostomy also play a role in the management. Current management strategies of csdhs remain widely controversial. Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles. Nonsurgical treatment of chronic subdural hematoma with. After therapy, the median volume for all 21 patients was 3.
Background chronic subdural haematoma csdh is one of the most common neurosurgical diseases. Subdural hematomas are relatively commonly encountered cases that always face neurosurgeons. The subacute phase begins 37 days after acute injury. The management of chronic subdural hematomas was retrospectively examined at a single institution among from 2011 to 2014. Chronic subdural hematoma csdh is one of the most frequent neurosurgical diseases with an incidence of about 17100,000year, increasing with age. However, because of the advanced age and medical problems of patients, surgical therapy is frequently associated with various complications. Surgery is the standard treatment for chronic subdural hematoma csdh, one of the common problems in neurosurgical practice. Managing chronic sdh no established standard of care exists for chronic sdh management. Chronic subdural haematoma is predominantly a disease of the elderly.
Nov 11, 2016 symptomatic chronic subdural hematoma csdh will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. A guide for patients and families 4 chronic subdural hematomas are sometimes hard to diagnose because their symptoms can resemble so many different conditions. The authors present a novel approach to the management of csh based on the use of dexamethasone as the. Chronic subdural hematoma csdh is a common pathology in neurosurgery, especially in the elderly patients, and its incidence is likely to double in the next decade. Management of recurrent subdural hematomas neurosurgery. Neurological state at the time of diagnosis is the most important prognostic factor. Verploegh, bsc, victor volovici, md, ruben dammers, md, phd, and lotte m.
Chronic subdural hematoma csdh is a commonly encountered condition in neurosurgical practices. Subdural hematoma sdh a guide for patients and families. Various surgical treatments of chronic subdural hematoma and. Hematoma staging com monly hinges on density of blood in the subdural space and timing relative to the precipitating event. They can be classified as acute chronic sdh 21 days, or as simple no associated parenchymal injury versus complicated associated underlying parenchymal injury. Nonoperative treatment of chronic subdural hematoma. Describe the pathophysiology of chronic subdural hematoma. Awake surgery in sitting position for chronic subdural hematoma.
Chronic subdural hematoma csdh and subacute subdural hematoma sasdh are the two most common neurosurgical diseases. A retrospective analysis of the instillation of tissue plasminogen activator in addition to twist drill or burr hole drainage in the treatment of chronic subdural hematomas. Nonsurgical management is reserved for asymptomatic or high. The incidence of chronic sdh has been reported as 1. Craniotomy does have its share in the management of. Chronic subdural hematoma csdh is an increasingly common neurological disease process. Chronic subdural hematoma can be treated with tranexamic acid without concomitant surgery. After participating in this cme activity, the neurosurgeon should be better able to. Chronic subdural hematoma is usually present in elderly persons, who have more prominent subdural spaces as a result of cerebral atrophy. Subdural hematomas may result in up to 8% of the patients shunted for normalpressure hydrocephalus 33. Chronic subdural hematoma represents the gradual accumulation of liquefied hematoma in the subdural space, occurring over 2 or more weeks.
The role of corticosteroids in the management of chronic. Chronic subdural hematoma csdh, which is characterized by a time course of weeks to months, has become an increasingly detected neurosurgical disease. Remember, a chronic subdural hematoma may not show symptoms for days, weeks and even months. Pdf chronic subdural hematoma management a systematic. However, to the best of the authors knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach. Chronic subdural hematomas may take weeks to months to appear. Current management strategies of chronic subdural hematomas remain. Mar 16, 2020 endoscopic management of chronic subdural hematoma.
Mar, 2015 previously, csdh was seen simply as the chronic form of acute subdural hematoma. Dexamethasone treatment in chronic subdural haematoma. Despite the wide prevalence of csdh, there remains a lack of consensus regarding numerous aspects of its clinical management. Assessing and managing patients with chronic subdural.
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