This protocol addresses the specific clinical situation of chronic subdural hematoma (cSDH) presenting with mild neurological symptoms or no symptoms at all — a subset in which many patients carry significant comorbidities that elevate their surgical risk and directly shape management decisions.
In cSDH patients with mild or absent symptoms, observation is frequently the initial recommendation. This is particularly true when major comorbidities place the patient in a high surgical risk category, requiring careful weighing of intervention benefits against procedural risk.
Success is assessed by serial CT imaging at 3 to 6 months, with adequate hematoma regression defined as a reduction to less than 10 mm in greatest thickness, or a 50% or greater decrease in volume.
DOI: 10.1161/STROKEAHA.123.044129
For patients with mild symptoms or for patients who are asymptomatic, observation is frequently recommended, particularly for patients with major comorbidities that place them in a high surgical risk category.
Early data suggest that the percentage of patients with nonsurgically managed cSDH who ultimately require surgical drainage is ≈20%; however, the rate of treatment failure with conservative management in contemporary medical practice is unknown.
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.