Indications for surgical therapy include:
- Pronounced neurologic symptoms
- Increased intracranial pressure (IPC).
- Fresh hemorrhage
- Seizures
- Space-occupying hematomas (bruises)
Time management:
- In case of acute SDH, the intervention must be performed immediately
- In chronic SDH, the intervention may be performed later, depending on the symptoms
Surgical procedures
For smaller hematomas, a burr hole trephination is suitable to drain the hematoma by means of a drainage (provided that the hematoma is liquid rather than solid). Often a very small drill hole (“mini-drill hole”) of 5 mm is already sufficient. This minimally invasive procedure can be performed under local anesthesia.In the setting of an acute subdural hemorrhage, the blood immediately clots and becomes very solid, so that the hematoma can only be removed via a craniotomy (opening of the skull). It is also usually larger than a chronic subdural hematoma.
A subdural hematoma can form again. Placement of a drain can reduce the risk of recurrence.
