Surgical treatment and recurrence of chronic subdural hematoma

Abstract

Background: The incidence of chronic subdural hematoma (CSDH) is increasing owing to the rapid growth of the elderly population. CSDH causes various neurological symptoms such as cognitive impairment and motor dysfunction, which can improve with appropriate surgical management.Current Concepts: CSDH usually comprises a hemorrhagic fluid that accumulates within the subdural space and compresses the brain. Surgery is indicated if CSDH is associated with neurological symptoms and is aimed at safe and sufficient drainage of the hematoma. Currently, the recommended primary surgical method involves insertion of a draining catheter after burr hole or twist-drill trephination to facilitate drainage of the hematoma over a couple of days. Craniotomy is limited to cases of organized or calcified hematoma. The postoperative recurrence rate is approximately 10% to 20%. The same treatment method is attempted in cases of recurrence.Discussion and Conclusion: Surgical methods aim for rapid symptom relief and minimal invasiveness. Trephination and indwelling subdural catheter placement can enable immediate drainage of the hematoma and can be performed under local anesthesia. Preoperatively, it is necessary to obtain an accurate medical and medication history of elderly patients. Except in cases of emergencies, it is preferable to select the timing of the surgery only after reversal of the effects of drugs to prevent surgical complications in patients who receive anticoagulants or antiplatelet agents. Close postoperative follow-up is necessary in elderly patients because insufficient brain expansion leads to maintenance of the subdural space and is associated with a high risk of recurrence.