Surgical management of acute subdural hematomas

M. Ross Bullock, Randall Chesnut, Jamshid Ghajar, David Gordon, Roger Hartl, David W. Newell, Franco Servadei, Beverly C. Walters, Jack E. Wilberger

Research output: Contribution to journalReview articlepeer-review

218 Scopus citations


In patients with an acute SDH, clot thickness or volume and the MLS on the preoperative CT correlate with outcome. In studies analyzing CT parameters that may be predictive for delayed surgery in patients undergoing initial nonoperative management, an MLS greater than 5 mm or a clot thickness greater than 10 mm on the initial CT scan emerged as significant prognostic factors (see Appendices for measurement techniques). Therefore, patients with SDH presenting with a clot thickness greater than 10 mm or an MLS greater than 5 mm should undergo surgical evacuation, regardless of their GCS. Patients who present in a coma (GCS < 9) but with an SDH with a thickness less than 10 mm and an MLS less than 5 mm can be treated nonoperatively, providing that they undergo ICP monitoring, they are neurologically stable since the injury, they have no pupillary abnormalities, and they have no intracranial hypertension (ICP > 20 mm Hg). Because of the frequent association of SDH with parenchymal injury, surgical management decisions should take into consideration the recommendations for both lesion types.

Original languageEnglish (US)
Pages (from-to)S216-S224
Issue numberSUPPL. 3
StatePublished - Mar 2006


  • Coma
  • Computed tomographic parameters
  • Craniotomy
  • Decompressive craniectomy
  • Head injury
  • Hematoma
  • Intracranial pressure monitoring
  • Salvageability
  • Subdural
  • Surgical technique
  • Timing of surgery
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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