Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

Abstract

Chronic subdural hematoma (CSDH) is a common neurosurgical disease encountered by neurologists, neurosurgeons, intensive care specialists, and emergency physicians in the emergency department. Although much has been published on CSDH, it remains a topic of active research, also a significant challenge in specific scenarios. The spectrum of clinical presentation varies from asymptomatic radiological entity to significant sensory-motor deterioration resulting in a comatose state. The majority of these cases have an underlying history of trivial trauma in one or the other form. More often, elderly individuals present with CSDH. Management of CSDH in elderly individuals presents specific challenges due to pre-existing comorbidities and medications which alter the pathophysiology. There exists a significant diversity in the treatment modality of CSDH amongst neurosurgeons. The treatment modality includes medical management as well as various forms of surgical manoeuvres intended to evacuate the hematoma and hence alleviate the mass effect over the surrounding brain matter. The treatment modality needs to be individualized for every case. The rationale selection of cases for medical and surgical intervention with robust follow-up results in a better prognostication of these cases.