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).