Chronic bilateral subdural haematoma in adults

Area of Science:

• Neurosurgery
• Neurology
• Trauma Surgery

Background:

• Chronic bilateral subdural hematomas (CBSDH) present a significant neurosurgical challenge.
• Surgical intervention is the primary treatment modality for CBSDH.
• Understanding patient demographics, clinical presentation, and surgical outcomes is crucial for optimizing management.

Purpose of the Study:

• To analyze the surgical treatment outcomes for patients with chronic bilateral subdural hematomas.
• To identify key clinical features, pre-operative symptoms, and their correlation with outcomes.
• To evaluate the efficacy and safety of surgical evacuation, emphasizing bilateral versus unilateral approaches.

Main Methods:

• Retrospective analysis of 29 patients surgically treated for chronic bilateral subdural hematomas between 1966 and 1977.
• Data collection included patient demographics, history of head trauma, presenting symptoms, operative details, and post-operative outcomes.
• Hematoma thickness and patient age were correlated with clinical findings.

Main Results:

• 83% of patients had a history of head injury; mean age was 60 years.
• Common symptoms included headache (72%), mental changes (48%), and papilledema (41%).
• Mortality was 10% (3/29), with deaths linked to delayed diagnosis or unilateral evacuation, particularly in patients with reduced consciousness.

Conclusions:

• Surgical evacuation of chronic bilateral subdural hematomas can lead to good functional recovery, with 23/26 survivors achieving full independence.
• Simultaneous bilateral surgical evacuation is strongly recommended to prevent midline shift and brainstem compression, thereby improving patient outcomes.
• Prompt diagnosis and bilateral surgical intervention are critical for reducing mortality in patients with chronic bilateral subdural hematomas.