Chronic Subdural Haematoma: Modern Management and Emerging Therapies

Overview

Journal Nat Rev Neurol

Specialty Neurology

Date 2014 Sep 17

PMID 25224156

Citations 145

Authors

Angelos G Kolias

Aswin Chari

Thomas Santarius

Peter J Hutchinson

Affiliations

Soon will be listed here.

Abstract

Chronic subdural haematoma (CSDH) is one of the most common neurological disorders, and is especially prevalent among elderly individuals. Surgical evacuation is the mainstay of management for symptomatic patients or haematomas exerting significant mass effect. Although burr hole craniostomy is the most widely practised technique worldwide, approximately 10-20% of surgically treated patients experience postoperative recurrence necessitating reoperation. Given the increasing incidence of CSDH in a growing elderly population, a need exists for refined techniques that combine a minimally invasive approach with clinical efficacy and cost-effectiveness. In addition, nonsurgical treatment modalities, such as steroids, are attracting considerable interest, as they have the potential to reduce postoperative recurrence or even replace the need for surgery in selected patients. This Review provides an overview of the contemporary management of CSDH and presents considerations regarding future approaches that could further optimize patient care and outcomes.

Citing Articles

Burr hole evacuation of chronic subdural hematoma in general versus local anesthesia: a systematic review and meta-analysis.

Weber C, Ferdowssian K, Hecht N, Vajkoczy P, Wessels L, Mertens R Acta Neurochir (Wien). 2025; 167(1):66.

PMID: 40056228 PMC: 11890363. DOI: 10.1007/s00701-025-06475-x.

Factors Predicting Recurrence and Resolution of Chronic SDH after Surgery.

Vyas S, Sharma A Asian J Neurosurg. 2025; 20(1):112-118.

PMID: 40041592 PMC: 11875717. DOI: 10.1055/s-0044-1796663.

Letter to the Editor Concerning ''Risk Factors for the Recurrence of Chronic Subdural Hematoma".

Gu Y, Wu X Korean J Neurotrauma. 2025; 21(1):60-61.

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Subgaleal drainage with one burr-hole for chronic subdural hematomas: Our two-years' experience.

Schmidt F, Schon V, Petr O, Freyschlag C, Thome C Brain Spine. 2025; 5:104185.

PMID: 39898004 PMC: 11787435. DOI: 10.1016/j.bas.2025.104185.

Middle meningeal artery embolization for recurrent subdural hematoma in an extra-intracranial anastomosis patient on anticoagulant medication: A case report.

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References

Forster M, Mathe A, Senft C, Scharrer I, Seifert V, Gerlach R . The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic subdural hematoma. J Clin Neurosci. 2010; 17(8):975-9. DOI: 10.1016/j.jocn.2009.11.023. View

Chari A, Kolias A, Santarius T, Bond S, Hutchinson P . Twist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma. J Neurosurg. 2014; 121(1):176-83. DOI: 10.3171/2014.4.JNS131212. View

Maas A, Murray G, Roozenbeek B, Lingsma H, Butcher I, McHugh G . Advancing care for traumatic brain injury: findings from the IMPACT studies and perspectives on future research. Lancet Neurol. 2013; 12(12):1200-10. PMC: 3895622. DOI: 10.1016/S1474-4422(13)70234-5. View

Delgado P, Cogolludo F, Mateo O, Cancela P, Garcia R, Carrillo R . [Early prognosis in chronic subdural hematomas. Multivariate analysis of 137 cases]. Rev Neurol. 2000; 30(9):811-7. View

Smith M, Kishikova L, Norris J . Surgical management of chronic subdural haematoma: one hole or two?. Int J Surg. 2012; 10(9):450-2. DOI: 10.1016/j.ijsu.2012.08.005. View

Yeon J, Kong D, Hong S . Safety of early warfarin resumption following burr hole drainage for warfarin-associated subacute or chronic subdural hemorrhage. J Neurotrauma. 2011; 29(7):1334-41. DOI: 10.1089/neu.2011.2074. View

Van Der Veken J, Duerinck J, Buyl R, Van Rompaey K, Herregodts P, DHaens J . Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma--a retrospective analysis. Acta Neurochir (Wien). 2014; 156(5):981-7. DOI: 10.1007/s00701-014-2042-8. View

Belkhair S, Pickett G . One versus double burr holes for treating chronic subdural hematoma meta-analysis. Can J Neurol Sci. 2012; 40(1):56-60. DOI: 10.1017/s0317167100012956. View

Nakaguchi H, Tanishima T, YOSHIMASU N . Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg. 2002; 95(2):256-62. DOI: 10.3171/jns.2001.95.2.0256. View

10.

Mori K, Maeda M . Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001; 41(8):371-81. DOI: 10.2176/nmc.41.371. View

11.

Wassef S, Abel T, Grossbach A, Viljoen S, Jackson A, Howard 3rd M . Traumatic intracranial hemorrhage in patients taking dabigatran: report of 3 cases and review of the literature. Neurosurgery. 2013; 73(2):E368-73. DOI: 10.1227/01.neu.0000430763.95349.5f. View

12.

Ramachandran R, Hegde T . Chronic subdural hematomas--causes of morbidity and mortality. Surg Neurol. 2007; 67(4):367-72. DOI: 10.1016/j.surneu.2006.07.022. View

13.

Kalamatianos T, Stavrinou L, Koutsarnakis C, Psachoulia C, Sakas D, Stranjalis G . PlGF and sVEGFR-1 in chronic subdural hematoma: implications for hematoma development. J Neurosurg. 2012; 118(2):353-7. DOI: 10.3171/2012.10.JNS12327. View

14.

Imaizumi S, Onuma T, Kameyama M, Naganuma H . Organized chronic subdural hematoma requiring craniotomy--five case reports. Neurol Med Chir (Tokyo). 2001; 41(1):19-24. DOI: 10.2176/nmc.41.19. View

15.

Grobelny B, Ducruet A, Zacharia B, Hickman Z, Andersen K, Sussman E . Preoperative antiepileptic drug administration and the incidence of postoperative seizures following bur hole-treated chronic subdural hematoma. J Neurosurg. 2009; 111(6):1257-62. DOI: 10.3171/2009.6.JNS0928. View

16.

Hubschmann O . Twist drill craniostomy in the treatment of chronic and subacute subdural hematomas in severely ill and elderly patients. Neurosurgery. 1980; 6(3):233-6. View

17.

Tugcu B, Tanriverdi O, Baydin S, Hergunsel B, Gunaldi O, Ofluoglu E . Can recurrence of chronic subdural hematoma be predicted? A retrospective analysis of 292 cases. J Neurol Surg A Cent Eur Neurosurg. 2013; 75(1):37-41. DOI: 10.1055/s-0032-1330961. View

18.

Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J . European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2013; 15(5):625-51. DOI: 10.1093/europace/eut083. View

19.

Muzii V, Bistazzoni S, Zalaffi A, Carangelo B, Mariottini A, Palma L . Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study. J Neurosurg Sci. 2005; 49(2):41-6. View

20.

Berghauser Pont L, Dippel D, Verweij B, Dirven C, Dammers R . Ambivalence among neurologists and neurosurgeons on the treatment of chronic subdural hematoma: a national survey. Acta Neurol Belg. 2012; 113(1):55-9. DOI: 10.1007/s13760-012-0130-1. View