From the Research
The inpatient treatment approach for subdural hematoma varies based on size, with small hematomas (<10mm thickness with minimal midline shift) often managed conservatively, while larger hematomas (>10mm thickness or with significant midline shift >5mm) typically require surgical evacuation, as supported by the most recent and highest quality study 1.
Key Considerations
- The treatment choice depends on the patient's clinical status, hematoma characteristics, and underlying conditions, with the primary goal being to relieve pressure on the brain and prevent secondary injury from mass effect and potential herniation.
- Surgical options include burr hole craniostomy for chronic subdural hematomas, which involves drilling small holes in the skull to drain the collection, or craniotomy for acute hematomas, which provides better access for removing solid clots, as noted in 2 and 1.
- Post-operatively, patients require close neurological monitoring, management of intracranial pressure, seizure prophylaxis with medications like levetiracetam (500-1000mg twice daily), and gradual mobilization.
Size-Based Treatment Approach
- Small hematomas (<10mm thickness with minimal midline shift): conservative management through observation, serial neurological examinations, and repeat imaging, as suggested by 3 and 1.
- Larger hematomas (>10mm thickness or with significant midline shift >5mm): surgical evacuation, as recommended by 1.
Additional Factors Influencing Treatment
- Patient's clinical status, including Glasgow Coma Scale score and presence of neurological symptoms, as discussed in 4 and 1.
- Underlying conditions, such as coagulopathies or use of anticoagulants, which may impact treatment choice, as noted in 5.
- Hematoma characteristics, including location and presence of midline shift, which can influence surgical approach, as described in 2 and 1.