Subdural haematoma - Treating subdural haematoma

Surgery is usually recommended to treat a subdural haematoma. A very small subdural haematoma may be carefully monitored first to see if it heals without the need for an operation.

Surgery is usually recommended for acute subdural haematomas that are 10mm (0.4 inches) or larger, and for most cases of chronic subdural haematomas.

Surgery

There are two widely used surgical techniques to treat a subdural haematoma:

• craniotomy – a section of the skull is temporarily removed to allow the surgeon access and remove the haematoma
• burr holes – a small hole is drilled into the skull and a tube is inserted through the hole to help drain the haematoma

These techniques are discussed in more detail below.

Craniotomy

A craniotomy is used for acute subdural haematomas and some chronic subdural haematomas. The surgery is carried out by a neurosurgeon (an expert in surgery of the brain and nervous system). A craniotomy usually takes a few hours to complete.

The neurosurgeon temporarily removes a section of the skull. The location of the piece of skull to be removed depends on where the subdural haematoma is. The blood clot is gently removed using suction and irrigation (washing away with water). After the procedure, the removed section of skull is replaced and fixed using strong stitches or small mini-plates.

A craniotomy is usually performed under a general anaesthetic, which means that you will be asleep during the surgery.

The most common complication of a craniotomy is that a blood clot develops at the site of the surgery. This occurs in an estimated one in 20 cases and will require further surgery to remove the blood clot.

Less common complications of a craniotomy include:

• stroke
• damage to nerves, which could result in muscle weakness or paralysis
• loss of some mental functions, such as memory loss

If the surgery goes well and you do not have any complications, you may be well enough to leave hospital after a few days. If you have complications, it may be several weeks before you are well enough to leave hospital.

Burr holes

Burr holes are usually the preferred treatment option for most chronic subdural haematoma cases. The process involves making tiny holes in the skull to allow the neurosurgeon to drain the blood from the subdural haematoma. The haematoma is drained through a flexible rubber tube fed through the burr holes.

Burr hole surgery is sometimes carried out under local anaesthetic, which means that the area is numbed, so you will not feel any pain, although you will be awake during the procedure.

Small tubes may be temporally left inside the burr holes for a few days to help drain away any blood and debris from the site of the surgery. Research results published in 2009 reported that using drainage tubes reduces the risk of complications.

After the procedure, the burr holes can be closed using either stitches or staples. Most people are well enough to leave hospital within three to nine days.

Complications of burr hole surgery include:

• post-operative infection
• excessive bleeding at the site of the surgery
• stroke

Symptoms that occurred before surgery may persist after surgery – for example:

• hemiparesis – muscle weakness on one side of the body
• dysphasia – problems with certain brain functions that affect talking and understanding others

Recurrence of the haematoma occurs in an estimated one in 10 cases and may require further surgery to correct.