From surgery to recovery, a step-by-step guide to the treatment journey for chronic subdural hematoma

Author: Zhang Tong, Chief Physician, China Rehabilitation Research Center (Beijing Boai Hospital)

Reviewer: Xu Jun, Chief Physician, Beijing Tiantan Hospital, Capital Medical University

In daily life, head injury is an issue that cannot be ignored, especially for the elderly, even minor bumps or collisions may have serious consequences.

Chronic subdural hematoma, as the name suggests, refers to chronic bleeding in the subdural space. This type of hematoma usually gradually shows symptoms more than three weeks after a head injury. Due to its long course, it is often easily ignored, which may bring serious consequences.

Fortunately, with the continuous advancement of medical technology, chronic subdural hematoma is no longer an insurmountable obstacle. From precise surgical treatment to meticulous postoperative care and rehabilitation, every step has lit up the light of hope for us.

The treatment of chronic subdural hematoma usually relies on surgical intervention. Due to the long course of the disease, the hematoma has been relatively stable but persists, and the pressure on the brain tissue is increasing, so conservative treatment is often difficult to work. The main methods of surgical treatment include skull drilling cleaning and closed drainage. The doctor will drill a hole in the skull to remove the hematoma in the subdural space and place a drainage tube to drain the accumulated fluid, thereby relieving the symptoms of increased intracranial pressure and brain tissue compression. For patients with a long course of disease and thicker hematoma walls, craniotomy may be required to completely remove the hematoma walls to achieve better treatment results.

Figure 1 Original copyright image, no permission to reprint

The safety of surgery is a common concern of patients and their families. With the advancement of medical technology and the improvement of surgical skills, the safety of chronic subdural hematoma surgery has been significantly improved. However, any surgery has certain risks, such as drilling too deep and possibly touching brain tissue, incomplete hematoma removal, or additional damage caused by careless operation.

Postoperative care is also crucial. Patients and their families need to pay close attention to the condition of the drainage tube and pay attention to the changes in the color and amount of the drainage fluid, which are important indicators for judging the recovery process. Maintaining good posture management, such as raising the feet moderately, helps promote blood circulation. Adequate water intake, 3000-5000 ml per day, helps maintain a normal intracranial environment. Understand the role of the drainage tube. Whether it is drilling or craniotomy, its purpose is to help wound healing and recovery. In terms of drug treatment, follow the doctor's orders and avoid unnecessary medication to avoid interfering with the recovery process.

The recovery time depends on the degree of preoperative neurological damage. Patients with mild intracranial hypertension can often recover quickly after the pressure is relieved. However, patients with hemiplegia or intellectual impairment need to use drug intervention and rehabilitation training, such as cognitive function drugs and rehabilitation training, to promote the recovery of speech and limb functions. Absolute rest is not recommended during the recovery period. Normal life is encouraged, and appropriate exercise can be performed after full recovery. In addition, for patients with a history of alcoholism, postoperatively is a good opportunity to adjust their lifestyle habits and limit alcohol intake, which is beneficial to overall health.

It is worth noting that children and the elderly need special considerations in the treatment of chronic subdural hematoma. Chronic subdural hematoma in children is mostly caused by birth trauma, and bilateral disease is more common. Using the unclosed anterior fontanelle unique to children for drainage provides an advantageous approach for surgical treatment. Because children have a strong compensatory ability during brain development, timely treatment can often avoid long-term sequelae.

Figure 2 Original copyright image, no permission to reprint

For the elderly, even if the initial symptoms are mild after a head bump or collision, they should seek medical attention in time to eliminate potential risks. Subdural hematoma is more likely to occur after a head injury in the elderly, and the condition may progress rapidly, so it is important to closely observe changes in the condition and promptly review imaging examinations such as CT.