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Bilateral chronic subdural hematoma treatment

Occasionally patients with Bilateral chronic subdural hematoma undergo unilateral surgery because the contralateral hematoma is deemed to be asymptomatic, and in some of these patients the contralateral hematoma may subsequently enlarge, requiring additional surgery.

Treatment of bilateral CSHs presents its own unique set of problems. New hemorrhage on the contralateral side and midline shift are concerns and can be avoided by simultaneous bilateral decompression 1) 2). and significantly lowers the risk of retreatment compared with unilateral intervention and should be considered when choosing a surgical procedure 3).

Results of a study of Motiei-Langroudi et al. from the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, Ohio State University Wexner Medical Center, Columbus, King Fahad Medical City, Riyadh, Saudi Arabia and Hamilton General Hospital, McMaster University, Hamilton ON, Canada, showed that most bCSDHs evacuated unilaterally do not experience growth in the nonoperated side and unilateral evacuation results in hematoma resolution for both sides in most cases. Hematoma thickness on the opposite side on the first postoperative day CT and amount of midline shift reversal after surgery are the most important factors predicting the need for surgery on the opposite side 4).

For Huang et al. neurological deterioration resulting from the thicker hematomas, early surgical decompression for bilateral CSDH should be implemented 5).


Sadrolhefazi A, Bloomfield SM. Interhemispheric and bilateral chronic subdural hematoma. Neurosurg Clin N Am. 2000 Jul;11(3):455-63. Review. PubMed PMID: 10918015.
Kurokawa Y, Ishizaki E, Inaba K. Bilateral chronic subdural hematoma cases showing rapid and progressive aggravation. Surg Neurol. 2005 Nov;64(5):444-9; discussion 449. PubMed PMID: 16253697.
Andersen-Ranberg NC, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. Bilateral chronic subdural hematoma: unilateral or bilateral drainage? J Neurosurg. 2017 Jun;126(6):1905-1911. doi: 10.3171/2016.4.JNS152642. Epub 2016 Jul 8. PubMed PMID: 27392267.
Motiei-Langroudi R, Thomas AJ, Ascanio L, Alturki A, Papavassiliou E, Kasper EM, Arle J, Alterman RL, Ogilvy CS, Stippler M. Factors Predicting the Need for Surgery of the Opposite Side After Unilateral Evacuation of Bilateral Chronic Subdural Hematomas. Neurosurgery. 2018 Sep 27. doi: 10.1093/neuros/nyy432. [Epub ahead of print] PubMed PMID: 30265326.
Huang YH, Yang KY, Lee TC, Liao CC. Bilateral chronic subdural hematoma: what is the clinical significance? Int J Surg. 2013;11(7):544-8. doi: 10.1016/j.ijsu.2013.05.007. Epub 2013 May 24. PubMed PMID: 23707986.
bilateral_chronic_subdural_hematoma_treatment.txt · Last modified: 2018/09/29 14:08 by administrador