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Acute subdural hematoma surgery


Acute subdural hematoma (ASDH) causing significant mass effect, which may be effectively reduced by surgery, is supposed to be an indication for surgery.

In general, initial surgical indication may be based on the patients GCS score, pupillary examination, and CT findings. Neurological deterioration and/or increase in ICP may also be an important factor in delayed decision 1).

Presurgical management

Although the presurgical management of patients with acute traumatic subdural hematoma prioritizes rapid transport to the operating room, there is conflicting evidence regarding the importance of time interval from injury to surgery with regards to outcomes.

Surgical Technique

Acute Subdural Hematoma Surgical Technique.


Significantly better outcome of clinical recovery with less cases of morbidity and deaths had occurred in patients in which TSDH was removed with the Decompressive craniectomy (DC) technique within 24 hours after the time of injury and also if a DC surface had had size over 40 ccm, in comparison to the group of patients that had TSDH removed with DC technique within longer period of time than 24 hours after the time of injury and also better than the control group 2).

In surgery for acute subdural hematoma (ASDH), the bone flap can be fixed onto the skull, or left “riding” to provide partial skull decompression, or removed.

A study concluded that removing the bone flap after ASDH evacuation was not associated with a better outcome, and recommend replacing the bone flap if brain conditions allow. Further research is required to evaluate the role of skull decompression in surgery for ASDH 3).

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient.


Shima K, Aruga T, Onuma T, Shigemori M; members of the Japanese Guidelines Committee on the Management of Severe Head Injury (2nd Edition), and the Japan Society of Neurotraumatology. JSNT-Guidelines for the Management of Severe Head Injury (Abridged edition). Asian J Neurosurg. 2010 Jan;5(1):15-23. PubMed PMID: 22028739; PubMed Central PMCID: PMC3198659.
Girotto D, Ledić D, Daji V, Vujković Z, Mihelcić N. Neurosurgical procedure for treatment of traumatic subdural hematoma with severe brain injury: a single center matched-pair analysis. Coll Antropol. 2014 Dec;38(4):1255-8. PubMed PMID: 25842771.
Tsermoulas G, Shah O, Wijesinghe HE, Silva AH, Ramalingam SK, Belli A. Surgery for acute subdural haematoma: replace or remove the bone flap? World Neurosurg. 2015 Oct 30. pii: S1878-8750(15)01389-3. doi: 10.1016/j.wneu.2015.10.045. [Epub ahead of print] PubMed PMID: 26523763.
acute_subdural_hematoma_surgery.txt · Last modified: 2019/04/22 23:47 by administrador