An Algorithm for Treatment of Symptomatic Chronic Subdural Hematomas.

Area of Science:

• Neurosurgery
• Medical Algorithms
• Minimally Invasive Procedures

Background:

• Chronic subdural hematoma (CSDH) is a common neurosurgical condition.
• Current treatment algorithms for CSDH are lacking.
• This study addresses the need for a structured treatment approach for symptomatic CSDH.

Purpose of the Study:

• To describe and evaluate an institutional algorithm for treating symptomatic CSDH.
• The algorithm aims to decrease symptoms and hematoma size.
• To minimize the need for invasive procedures like craniotomy.

Main Methods:

• A retrospective study of 109 patients with CSDH treated between 2019 and 2023.
• Patients were treated using an algorithm starting with subdural drain (SDD) placement via twist-drill craniostomy (TDC).
• Second-line treatment included tissue plasminogen activator (tPA), with craniotomy as a last resort.

Main Results:

• TDC with or without tPA showed significant clinical and radiographic improvement.
• Patients treated with the algorithm had greater hematoma drainage and fewer neomembranes compared to those requiring craniotomy.
• Only patients treated following the algorithm demonstrated clinical and radiographic improvement, with fewer readmissions.

Conclusions:

• The institutional algorithm for symptomatic CSDH is effective.
• Minimally invasive interventions like SDD via TDC and tPA can successfully treat CSDH.
• This approach reduces the necessity for more invasive treatments such as craniotomy.