Chronic subdural hematoma evacuation is a neurosurgical procedure that removes blood which has slowly collected between the dura and the surface of the brain. It often follows a head injury, even a minor one, and is more likely in older adults and people taking blood thinners. Surgery aims to relieve pressure on the brain and improve symptoms. It is an emergency when consciousness, movement or speech worsens.
The operation is usually done under general anaesthesia, although local anaesthesia with sedation may sometimes suffice. The surgeon makes one or two small holes in the skull, occasionally a larger opening, drains the blood by gentle irrigation and may leave a temporary drain for a day or two.
Surgery often takes one to two hours, followed by several days of hospital monitoring. Many patients improve in the first days, but the collection can return in some, and full recovery usually takes from several weeks to a few months, with follow-up CT scans. The treating team plans care for each case.
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It relieves pressure on the brain and may improve headache, confusion, weakness and problems with speech or walking. The extent of improvement depends on the patient's age, how long symptoms have lasted and the state of the brain, and the treating team estimates it.
A patient with clear symptoms, or whose imaging shows pressure on the brain. Small collections without symptoms may only need observation. The neurosurgeon decides after a CT or MRI scan.
It is often carried out urgently after blood tests and imaging. It is essential to tell the doctor about all medicines, especially blood thinners, which must never be stopped or reversed except on the medical team's decision. Fasting is requested when possible.
After anaesthesia a small area of hair is shaved and the skin is opened, then one or more holes are made in the skull and the dura is opened. The surgeon drains the collected blood by gentle irrigation, places a temporary drain and closes the wound.
The patient is monitored in hospital for several days and is encouraged to move early when the doctor allows. Head injuries and strenuous activity are usually best avoided for several weeks, and the surgeon schedules follow-up CT scans.
Many patients improve within days to weeks, and full recovery may take months. Because the collection can return in some patients, symptoms should be watched and the head scanned again when needed.
They may include recurrence of the collection, bleeding, infection, seizures, air inside the skull, and heart or lung problems in older patients. Injury to the brain tissue itself is rare. The condition is serious, and the surgeon explains the risks for your situation.
A small scar remains on the scalp, usually covered by hair, and it fades with time. The shape of the head does not normally change noticeably after a small burr hole.
Waiting about two to four weeks is usually advised, after a scan confirming that the condition is stable, and the treating doctor sets the date. A patient should not travel if symptoms are getting worse.
If there is severe drowsiness, increasing confusion, a new severe headache, weakness in a limb, difficulty speaking, seizures or repeated vomiting. These may be signs of recurrence or another complication and call for going to the emergency department immediately.
