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  • Review Article
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Chronic subdural haematoma: modern management and emerging therapies

Nature Reviews Neurology volume 10, pages 570–578 (2014)Cite this article

Subjects

Key Points

  • Chronic subdural haematoma (CSDH) is a common neurological condition in elderly individuals, and its incidence is rising due to an ageing population and increasing use of anticoagulant and antiplatelet medication

  • Patients with CSDH are increasingly being managed by multidisciplinary teams—including neurologists and elderly care physicians—making it crucial for these specialities to be familiar with its presentation, diagnosis and management

  • CSDH can present heterogeneously, often mimicking stroke or dementia, but is usually easily diagnosed as a predominantly hypodense or isodense crescentic collection on unenhanced CT

  • Surgical evacuation via burr hole craniostomy is the most common treatment; recurrence is an important complication, affecting 10–20% of patients

  • Further work is required to refine the management of CSDH, including exploration of minimally invasive techniques and adjuvant treatments, such as steroids, that might reduce both recurrence and the need for surgery

Abstract

Chronic subdural haematoma (CSDH) is one of the most common neurological disorders, and is especially prevalent among elderly individuals. Surgical evacuation is the mainstay of management for symptomatic patients or haematomas exerting significant mass effect. Although burr hole craniostomy is the most widely practised technique worldwide, approximately 10–20% of surgically treated patients experience postoperative recurrence necessitating reoperation. Given the increasing incidence of CSDH in a growing elderly population, a need exists for refined techniques that combine a minimally invasive approach with clinical efficacy and cost-effectiveness. In addition, nonsurgical treatment modalities, such as steroids, are attracting considerable interest, as they have the potential to reduce postoperative recurrence or even replace the need for surgery in selected patients. This Review provides an overview of the contemporary management of CSDH and presents considerations regarding future approaches that could further optimize patient care and outcomes.

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Figure 1: The dural border cell layer.
Figure 2: Evolution of CSDH from ASDH.
Figure 3: Treatment pathway for patients with CSDH.
Figure 4: Surgical approaches for CSDH evacuation.

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Acknowledgements

A.G.K. is supported by a Royal College of Surgeons of England Research Fellowship, an National Institute of Health Research (NIHR) Academic Clinical Fellowship, and a Sackler Studentship. P.J.H. is supported by an NIHR Research Professorship and the NIHR Cambridge Biomedical Research Centre, and has been appointed as the Surgical Specialty Lead for Neurosurgery, Royal College of Surgeons of England Clinical Research Initiative.

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  1. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK

    Angelos G. Kolias, Aswin Chari, Thomas Santarius & Peter J. Hutchinson

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A.G.K. and A.C. wrote the first draft, which was revised by T.S. and P.J.H. All authors edited and approved the manuscript prior to submission. All authors satisfy International Committee of Medical Journal Editors criteria for authorship.

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Correspondence to Angelos G. Kolias.

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Kolias, A., Chari, A., Santarius, T. et al. Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol 10, 570–578 (2014). https://doi.org/10.1038/nrneurol.2014.163

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