Acute Subdural Hematoma Requiring Surgery in the Subacute or Chronic Stage

Abstract

The aim of this study was to clarify the clinical characteristics and pathophysiology of conservatively treated cases of acute subdural hematoma (ASDH) that ultimately require surgery in the subacute or chronic stage, and devise an appropriate form of management for them. A total of 50 patients with ASDH were admitted to our institution during a 5-year period. Hematoma removal in the subacute or chronic stage was performed in 8 patients. The ASDH had been caused by a fall in 5 patients. Five patients had been treated with antiplatelet agents. Fluid-attenuated inversion recovery magnetic resonance (MR) imaging demonstrated an irregularly shaped hematoma with gyrus patterns in 4 of 5 patients. Diffusion-weighted MR imaging demonstrated a two-layered hematoma structure in 3 of 4 patients. The hematoma was removed via a craniotomy, a small craniotomy, and a burr hole in 1, 1, and 6 patients, respectively. At surgery in the craniotomy case, a solid clot was located beneath the dura, and a liquid hematoma was located close to the brain. After hematoma removal, no inner membrane was observed on the brain surface. One patient had typical chronic subdural hematoma in the subacute stage, and 2 patients had so-called subacute subdural hematoma (SASDH) in the chronic stage. Although the majority of such cases can be treated by burr-hole surgery, a small craniotomy or craniotomy ought to be considered as a further surgical option if SASDH is diagnosed on the basis of clinical and radiological data, especially diffusion-weighted MR imaging.

Endoscopic hematoma evacuation for acute and subacute subdural hematoma in elderly patients

“…2,3,9,11,14 In a few previous reports bur hole surgery was performed for subacute SDH, with good outcomes. 5,6,16 Yamada et al reported on 20 patients in whom subacute SDH was treated with bur hole surgery. 16 Eighteen patients underwent surgery once, with no recurrence, and good recovery was achieved in 77.8% of cases.…”

The Effectiveness of Subdural Drains Using Urokinase after Burr Hole Evacuation of Subacute Subdural Hematoma in Elderly Patients: A Prelimilary Report

“…A hematoma formed between the dura mater and arachnoid is called a subdural hematoma (SDH), and it is known to occur in 5% to 29% of all head trauma patients 1619). It can even occur in patients with no trauma or minor trauma, such as those who take anticoagulants, have a blood disease, or have received a hydrocephalus shunt 7141519).…”

“…A subacute SDH (SASDH) is a hematoma occurring between 4 and 20 days after injury 69). Surgical treatment is required if neurological symptoms progress from mild to moderate or severe due to injury during the subacute stage (e.g., decreased consciousness, motor nerve palsy, headache), while patients receive conservative treatment for mild neurological symptoms due to acute SDH 6).…”

“…Surgical treatment is required if neurological symptoms progress from mild to moderate or severe due to injury during the subacute stage (e.g., decreased consciousness, motor nerve palsy, headache), while patients receive conservative treatment for mild neurological symptoms due to acute SDH 6). For SASDH, a burr hole or craniotomy should be considered.…”

Finite-Element Analysis of a New Designed Miniplate which is Used via Intraoral Approach to the Mandible Angle Fracture

“…1,2 Common causes of mandible fracture include physical assault, sports activities, motor vehicle accidents, industrial accidents, warfare, and falls. 3 Factors affecting fracture include the direction and amount of force as well as the biomechanical and anatomical properties of bone.…”