Patientem Fortuna Adiuvat: The Delayed Treatment of Surgical Acute Subdural Hematomas-A Case Series

World Neurosurgery
Joanna E GernsbackJonathan R Jagid

Abstract

Current guidelines prescribe emergent decompression of acute subdural hematomas (aSDHs) with width 10 mm or larger or midline shift 5 mm or larger. A subset of patients who meet these criteria, including those with high Glasgow Coma Scale (GCS) scores and coagulopathy because of medication or multiple medical comorbidities, may be treated conservatively until the hematoma can be removed by burr hole drainage. We present a series of conservatively managed surgical patients with aSDH, examining their hospital course and outcomes. Patients were included who met guidelines for surgery on admission but who had decompression delayed until it could be accomplished by burr hole drainage. Charts were reviewed for presentation, computed tomography scan findings, and outcomes. Patients were classified according to outcome and whether their eventual surgery was scheduled or emergent. Eighteen patients were included with a mean age of 70.2 years. Average GCS score at presentation was 14.6 ± 0.6. Most patients were using some form of blood-thinning medication at presentation (72.2%). Admission CT scan revealed aSDH with a mean width of 13.6 mm and midline shift of 6.6 mm. Average total length of stay was 28.4 ± 17.0 days, of which 14.2 ± 9.2...Continue Reading

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