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Subdural Hematoma Surgery

Background

A subdural hematoma (SDH) is a common neurosurgical disorder that often requires surgical intervention. It is a type of intracranial hemorrhage that occurs beneath the dura (essentially, a collection of blood over the surface of the brain) and may be associated with other brain injuries (see the images below).

Left-side acute subdural hematoma (SDH). Note high

Left-side acute subdural hematoma (SDH). Note high signal intensity of acute blood and (mild) midline shift of ventricles.

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Left-side chronic subdural hematoma (SDH). Note ef

Left-side chronic subdural hematoma (SDH). Note effacement of left lateral ventricle.

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SDHs can be associated with high mortality and morbidity, even when the best medical and neurosurgical care is provided. They are usually caused by trauma but can be spontaneous or result from a procedure (eg, lumbar puncture).
Anticoagulation (eg, with heparin or warfarin) may be a contributing factor.

The practice of trephination of the head (ie, chipping or drilling a hole through the skull) has been traced back to ancient times. In 1840, the French author Balzac described a case of chronic SDH, including its traumatic origin and surgical treatment.

In the late 19th century, with the rise of medicine, development of aseptic technique and anesthesia, and establishment of the basic principles of neurologic localization, surgery for intracranial lesions (including SDH) became more common and, later, survival rates improved.

In 1883, Hulke first described successful neurosurgical treatment of chronic SDH.
Although cerebral angiography could be used to localize SDHs in the early-to-middle 20th century, the development of computed tomography (CT) in the late 1970s represented another leap in patient care.

See also Subdural Hematoma, Emergent Management of Subdural Hematoma, Imaging in Subdural Hematoma, Closed Head Trauma, Head Injury, and Forensic Autopsy of Blunt Force Trauma.

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