Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy

Abstract

Objective: Chronic subdural hematoma (cSDH) is common condition in neurosurgical field. It is difficult to select the treatment modality between the surgical method and the conservative method when patients have no or mild symptoms. The purpose of this study is to provide a suggestion that the patients could be cured with conservative treatment modality.

Methods: We enrolled 16 patients who had received conservative treatment for cSDH without special medications which could affect hematoma resolution such as mannitol, steroids, tranexamic acid and angiotensin converting enzyme inhibitors. The patients were classified according to the Markwalder's Grading Scale.

Results: Among these 16 patients, 13 (81.3%) patients showed spontaneously resolved cSDH and 3 (18.7%) patients received surgery due to symptom aggravation and growing hematoma. They were categorized into two groups based on whether they were cured with conservative treatment or not. The first group was the spontaneous resolution group. The second group was the progression-surgery group. The mean hematoma volume in the spontaneous resolution group was 43.1 mL. The mean degree of midline shift in the spontaneous resolution group was 5.3 mm. The mean hematoma volume in the progression-surgery group was 62.0 mL. The mean degree of midline shift in the second group was 6 mm.

Conclusion: We suggest that the treatment modality should be determined according to the patient's symptoms and clinical condition and close observation could be performed in patients who do not have any symptoms or in patients who have mild to moderate headache without neurological deterioration.

Keywords: Chronic subdural hematoma; Close observation; Treatment.

Figures

Fig. 1. A 75-year-old male complained of mild headache and he had alert mentality after minor head trauma [Table 1 (Case 7)]. A : Initial brain CT reveals scanty acute SDH in the right hemisphere. B : Follow-up brain CT scan on the 20th hospital day (HD) shows liquefied subdural hematoma that compressed the brain parenchyma with a mild midline shift. C : Follow-up brain CT scan on the 46th HD shows an improved mass effect and a remarkably decreased amount of hematoma. D : Final brain CT scan reveals nearly complete resolution of the hematoma. SDH : subdural hematoma.

Fig. 2. A 25-year-old male presented with left side hemiparesis and headache [Table 1 (Case 2)]. A : Initial brain CT scan shows that a mixed subacute to chronic subdural hematoma compresses the brain parenchyma and causes a midline shift. B : Follow-up brain CT scan on the 14th hospital day (HD) reveals decreased amount of hematoma and mass effect. C : Follow-up brain CT scan on the 30th HD identifies remarkable reduction in hematoma volume. D : Final brain CT scan shows complete disappearance of the hematoma.

Fig. 3. An 81-year-old male presented with an incidental subdural hematoma [Table 2 (Case 1)]. A : Initial brain CT scan reveals an isodense lesion in the subdural space in bilateral convexity. B : When the symptom changed, follow-up brain CT shows an increased amount of hematoma. C : Post-operative brain CT scan shows reduction of hematoma through drainage catheters.