Tips and Pearls in Chronic Subdural Hematoma

Background and Aim: One of the most prevalent neurosurgery conditions is Chronic Subdural Hematoma (CSDH). Among neurosurgeons, there are various CSDH treatment approaches. Methods and Materials/Patients: This is a narrative review examining the various aspects of the CSDH. To provide uptodate information on CSDH, we concisely reviewed the related articles. All of the relevant articles retrieved from Google Scholar, PubMed, and Medline were reviewed and critically analyzed. We searched for keywords including chronic subdural hematoma, burr hole craniotomy versus craniostomy, middle meningeal artery embolization, conservative therapy versus surgical therapy in CSDH, and recurrence of CSDH in published articles from 19602020. Results: CSDH may present with various clinical presentations. Medical symptoms range from general and moderate symptoms (such as headache, tiredness) to severe symptoms (e.g. hemiparesis, coma). A definite trauma history may be obtained in most cases. Contrastenhanced CT or MRI may help diagnosis. The treatment choice for uncomplicated CSDH is BurrHole Craniotomy (BHC). The use of drainage to decrease recurrence rates has been shown to have limited outcomes in most recent studies. Craniotomy is also used for treatment. Only asymptomatic or highrisk operative patients are subjected to nonsurgical management. Conclusion: Management of CSDH is still contentious. It is widely agreed that if neurological signs and radiological observations are present, CSDH should be evacuated. Burrhole craniotomy appears to be the preferred surgical technique because, in most patients, it gives the best treatment outcomes. Several issues are still uncertain, including the proper surgical technique [Burrhole craniotomy versus Twist Drill Craniostomy (TDC) and craniotomy], the advantage of 2 perforated holes over one, the location of drainage, the impact of irrigation of the hematoma, and the duration of postoperative immobilization.