Treatment of Neurologically Stable Chronic Subdural Hematoma with Significant Symptoms
This protocol covers management of chronic subdural hematoma (cSDH) in patients who are neurologically stable but present with significant symptoms and imaging findings that place them in the surgical treatment range.
Clinical Scenario
The patient is neurologically stable yet carries significant symptoms associated with an initial hematoma thickness >10 mm or a brain midline shift >5 mm on imaging. Patients meeting these thresholds are typically considered candidates for surgical treatment.
Treatment Approach
Surgical evacuation is the standard of care for symptomatic, larger cSDH, with the specific operative technique and any adjunctive intervention tailored to the individual patient's profile.
Full technique selection, sequencing, and adjunct criteria are in the complete protocol.
Treatment Goal
Adequate hematoma regression on serial CT at 3 to 6 months — defined as a reduction to <10 mm in greatest thickness or a ≥50% reduction in volume.
References
DOI: 10.1161/STROKEAHA.123.044129
- Patients with significant symptoms are typically associated with an initial hematoma thickness >10 mm or a midline shift >5 mm, and they are typically considered for surgical treatment.
- Surgical evacuation of symptomatic and larger cSDH is the standard of care; however, patient outcomes are variable, and rates of recurrence are high.
- A variety of surgical techniques are routinely used for the evacuation of cSDH.
- Current data supports MMAE as an adjunct to conventional surgical or nonsurgical management.
- Imaging end points are based on serial CT studies being performed between 3 and 6 months after enrollment to assess for adequate regression of the hematoma volume.
- Adequate regression has been defined as either a reduction to <10 mm in the greatest thickness or ≥50% reduction in volume.
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