Subdural Hematoma: Past, Present, and Future Management

A subdural hematoma (SDH) is a collection of blood between the dura mater and arachnoid mater, the innermost and outermost layers of the meninges, the protective membranes that surround the brain. SDHs can be acute, subacute, or chronic depending on the time since the bleed occurred. Acute SDHs usually occur as a result of traumatic brain injury (TBI),while chronic SDHs can develop slowly and often have no identifiable cause.

Subdural Hematoma: Past to Present to Future Management

by Paul Warmbier

4.9 out of 5

Language	:	English
File size	:	39547 KB
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Enhanced typesetting	:	Enabled
Print length	:	980 pages
Paperback	:	239 pages
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Historical Management

The management of SDH has evolved significantly over the centuries. In the past, trephination, a procedure involving the drilling or scraping of a hole in the skull, was the primary treatment. This allowed the evacuation of the hematoma but also carried a high risk of infection and other complications.

In the early 20th century, the development of surgical techniques such as craniotomy and bone flap removal allowed for more precise removal of the hematoma. However, these procedures were still associated with a high morbidity and mortality rate.

Present Management

Today, the management of SDH is primarily surgical, and the choice of procedure depends on the size, location, and clinical presentation of the hematoma.

• Burr hole drainage: This is a minimally invasive procedure that involves drilling a small hole in the skull and aspirating the hematoma. It is usually used for small, acute SDHs.
• Craniotomy: This is a more extensive procedure that involves removing a bone flap from the skull to access and evacuate the hematoma. It is used for large or chronically organized SDHs.
• Endoscopic evacuation: This is a minimally invasive technique that uses a small camera and instruments to remove the hematoma. It is often used for SDHs in difficult-to-reach areas of the brain.

In addition to surgery, other supportive measures may be necessary, such as:

• Medical management: This may include medications to control seizures, reduce intracranial pressure, or prevent blood clots.
• Rehabilitation: This may include physical therapy, occupational therapy, and speech therapy to help improve function and quality of life.

Prognosis and Outcome

The prognosis for SDH varies depending on the size and location of the hematoma, as well as the patient's overall health and age. Overall, the mortality rate for SDH is around 15-20%.

Patients who survive an SDH may experience a range of functional deficits, including:

• Cognitive impairment
• Motor weakness or paralysis
• Sensory loss
• Seizures
• Speech and language problems

The severity and duration of these deficits can vary depending on the extent of brain damage caused by the hematoma.

Future Advancements

Current research in SDH management is focused on improving outcomes and reducing the risk of complications. Some promising areas of investigation include:

• Minimally invasive surgical techniques: New endoscopic and robotic-assisted techniques are being developed to allow for smaller incisions and reduced surgical trauma.
• Targeted drug therapies: Researchers are investigating drugs that can target specific molecules involved in SDH formation and progression.
• Brain monitoring: Advanced monitoring techniques, such as intracerebral pressure monitoring, are being used to better understand the effects of SDH on brain function and guide treatment decisions.

Subdural hematoma is a serious condition that can have significant long-term consequences. The management of SDH has improved dramatically over the years, but there is still room for improvement. Ongoing research is focused on developing new and more effective treatments that can improve outcomes and reduce the burden of this condition.

References

1. Frontera, J. A., & Stutzman, S. S. (2015). Cerebrospinal Fluid Disorders. In L. H. Bruns & M. H. Jankowski (Eds.),Handbook of Clinical Neurology (Vol. 128, pp. 457-475). Elsevier.
2. Mendelow, A. D., Karimi, A., Greenberg, R. M., & McMenomey, S. O. (2013). Hematoma. In J. Chen, S. F. Chang, N. M. Hadjiolov & N. Suzuki (Eds.),Textbook of Traumatic Brain Injury (pp. 331-344). Springer.
3. Ropper, A. H., & Zafonte, R. D. (2019). Subdural Hematoma. In Youmans and Winn Neurological Surgery (7th ed., Vol. 6, pp. 1863-1897). Elsevier.

Subdural Hematoma: Past to Present to Future Management

by Paul Warmbier

4.9 out of 5

Language	:	English
File size	:	39547 KB
Text-to-Speech	:	Enabled
Enhanced typesetting	:	Enabled
Print length	:	980 pages
Paperback	:	239 pages
Item Weight	:	12.6 ounces
Dimensions	:	6 x 0.6 x 9 inches
Screen Reader	:	Supported

FREE