From the Guidelines

Diagnosis and treatment of a subdural hematoma typically involves imaging studies and surgical intervention if necessary.

Imaging studies such as MRI or CT scans are used to diagnose subdural hematoma, with MRI being sensitive for the detection of small-volume extra-axial hemorrhage and evolving parenchymal injury 1.
The addition of contrast-enhanced MRI sequences can be used to improve evaluation of extra-axial collections and increase sensitivity for the detection of membranes in subdural collections 1.

Small or asymptomatic hematomas should be managed conservatively, while treating any underlying conditions such as a CSF leak 1.
Symptomatic hematomas with significant mass effect may require surgical intervention, such as burr hole drainage, in conjunction with treating the underlying condition 1.
The risk of progressive bleeding is greater for all forms of intracranial hemorrhage, including subdural hematoma, the earlier the baseline CT scan is performed and when coagulopathy is present 1.
The risk of significant expansion of acute subdural hematoma requiring rescue craniotomy is lower, ranging from 6% to 22%, within an intermediate time window of 12 to 24 hours 1.

From the Research

Subdural hematoma is a common entity encountered by neurosurgeons, with acute, subacute, and chronic forms 2
The disease has various forms and causes, including trauma, anticoagulant/antiaggregant use, arterial rupture, oncologic hemorrhages, intracranial hypotension, and idiopathic hemorrhages 2
Diagnosis is typically made using cranial CT scans, which can show the presence of a hematoma between the dura mater and the arachnoid layer of the brain 3, 4

Management of subdural hematoma changes according to the etiology of the lesion, with the main goals being decompression of neural tissue and restoration of perfusion 2
Surgical options for treatment include craniotomy, decompressive craniectomy, twist-drill, and burr-hole drainage, as well as the use of subdural drainage systems 5, 6
In children younger than 2 years of age, surgical treatment may involve transcutaneous subdural puncture, external subdural drainage, subdural-subgaleal shunt placement, or subdural-peritoneal shunt placement 4
The choice of treatment should be determined by the clinical and radiological characteristics of the individual case, with consideration of factors such as age, Glasgow Coma Scale score, and presence of co-existing lesions 4, 6

Chronic subdural hematoma (CSDH) is a collection of liquefied blood between the dura mater and the arachnoid layer of the brain, with an increasing incidence in older adults 3
Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury, with a high mortality rate due to its complicated pathophysiology 6
Management of ASDH may involve surgical procedures such as craniotomy, decompressive craniectomy, or initial trephination, with the goal of reducing intracranial pressure and improving outcomes 6