Management of Chronic Subdural Haematomas and Hygromas

Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 9)


Chronic subdural haematomas (Chr. S. H.) have an excellent prognosis if diagnosed and operated upon in time. Because of the straight forward nature of the surgery, the operation of Chr. S. H. is often entrusted to young doctors during their early stage of neurosurgical training as the first operative procedure they are allowed to perform alone within the central nervous system. This article therefore aims to give some guidelines to the young neurosurgeon, what to do and how to do it, to establish an orderly progression of treatments, beginning with the most simple and safe, only going on to more complicated operations if the simple possibilities fail. The reasons of failure and complications are discussed.


Subdural Haematoma Burr Hole Bone Flap Suction Drainage Chronic Subdural Haematoma 
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  1. Bender, M. B., Cristoff, N., 1974: Nonsurgical treatment of subdural hematomas. Arch. Neurol. 31, 73 79.Google Scholar
  2. Bouzarth, W. F., Hash, C. J., Lindermuth, J. R., 1980: Tension pneumocephalus following surgery for subdural hematoma. J. Trauma 20, 460–463.PubMedCrossRefGoogle Scholar
  3. Collins, W. F., Pucci, G. L., 1981: Peritoneal drainage of subdural hematomas in infants. J. Pediat. 58, 482–485.CrossRefGoogle Scholar
  4. Faulhauer, K., Herrmann, H.-D., Loew, F., 1973: Operative treatment of extremely large bilateral subdural effusions in infancy. Acta neurochir. (Wien) 28, 179–187.CrossRefGoogle Scholar
  5. Gardner, W. J., 1932: Traumatic subdural hematoma with particular reference to the latent interval. Arch. Neurol. Psychiat. 27, 847–858.Google Scholar
  6. Gjerris, T., Schmidt, K., 1974: Chronic subdural haematomas. Surgery or mannitol treatment. J. Neurosurg. 40, 639–642.PubMedCrossRefGoogle Scholar
  7. Hirsh, L. F., 1980: Intracranial air following subdural hematoma drainage with delayed recovery. Neurochirurgica (Stuttgart) 23, 55–58.Google Scholar
  8. Holmes, J., 1953: Intracranial hypotension associated with subdural haematoma. Brit. Med. J. 1, 1363–1366.PubMedCrossRefGoogle Scholar
  9. Ingraham, F. D., Heyl, H. L., 1939: Subdural hematoma in infancy and childhood. J. Amer. Med. Ass. 112, 198–204.Google Scholar
  10. Ito, H., Yamamoto, S., Kornai, T., Mizukoshi, H., 1976: Role of local hyperfibrinolysis in the etiology of chronic subdural hematoma. J. Neurosurg. 45, 26–31.PubMedCrossRefGoogle Scholar
  11. Jaeckle, K. A., Allen, J. H., 1979: Subdural hygroma: Diagnosis with computed tomography. CT: The J. of Computed Tomography 3, 201–206.CrossRefGoogle Scholar
  12. Kim, K. S., Hemmati, M., Weinberg. P. E., 1978: Computed tomography in isodense subdural hematoma. Radiology 128, 71–74.PubMedGoogle Scholar
  13. Krayenbühl, H., Noto, G. G., 1949: Das intrakranielle subdurale Hämatom. Bern: H. Huber.Google Scholar
  14. Kurti, Xh., Xhumari, A., Petrela, M., 1982: Bilateral chronic subdural haematomas; surgical or non-surgical treatment. Acta neurochir. (Wien) 62, 87–90.CrossRefGoogle Scholar
  15. Labadie, E. L., Glover, D., 1975: Local alterations of hemostatic-fibrinolytic mechanisms in reforming subdural hematomas. Neurology 25, 669–675.PubMedGoogle Scholar
  16. Loew, F., Wüstner, S., 1960: Diagnose, Behandlung und Prognose der traumatischen Hämatome des Schädelinneren. Acta neurochir. (Wien) Suppl. V III. Wien: Springer.Google Scholar
  17. Loew, F., Wüstner, S., Herrmann, II.-D., 1966: Die Schädel-Hirn-Verletzungen. In: Handbuch der gesamten Unfallheilkunde, Volume 2 (Bürkle de la Camp H., Schwaiger, M., eds.). Stuttgart: Enke.Google Scholar
  18. Loew, F., Wüstner, S., Kivelitz, R., 1976: Chronic subdural haematomas. In: Handbook of Clinical Neurology (Vinken, P. J., Bruyn, G. W., eds.). Vol. 24, Part II. Amsterdam-Oxford: North-Holland Publ. Co. and New York: American Elsevier Publ. Co.Google Scholar
  19. Markwalder, T. M., 1981: Chronic subdural hematomas: a review. J. Neurosurg. 54, 637–645.PubMedCrossRefGoogle Scholar
  20. Moeller, A., Ericson, K., 1979: Computed tomography of isoattenuating subdural hematomas. Radiology 130, 149–152.Google Scholar
  21. Nägle, W., 1982: Ergebnisse verschiedener Behandlungsverfahren beim chronischen subduralen Hämatom. Diss. Saarbrücken-Homburg.Google Scholar
  22. Njiokiktjien, C. J., Valk, J., Ponssen, H., 1980: Subdural hygroma: Results of treatment by ventriculo-abdominal shunt. Child’s Brain 7, 285 302.Google Scholar
  23. Pertuiset, B., Chavany, J. A., Weil, B., 1953: A propos d’un coma très singulier Collapsus cérébral spontané et hématome sous dural secondaire. Presse Méd. 61, 6, 112–113.PubMedGoogle Scholar
  24. Hagenmüller, D., 1954: Les troubles hormonaux observés au cours de l’évolution d’un hématome sous dural spontané et récidivant. Mschr. Psychiat. Neurol. 128, 315–326.CrossRefGoogle Scholar
  25. Sato, S., Suzuki, J., 1975: Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J. Neurosurg. 43, 569–578.PubMedCrossRefGoogle Scholar
  26. Shulman, K., Ransohoff J., 1961: Subdural haematoma in children. The fate of children with retained membranes. J. Neurosurg. 18, 175–181.CrossRefGoogle Scholar
  27. Suzuki, J., Takaku, A., 1970: Nonsurgical treatment of chronic subdural hematoma. J. Neurosurg. 33, 548–553.PubMedCrossRefGoogle Scholar
  28. Tsai, F. Y., Huprich, J. E., Segall, H. D., Teal, J. S., 1979: The contrast-enhanced CT scan in the diagnosis of isodense subdural haematoma. J. Neurosurg. 50, 64–69.PubMedCrossRefGoogle Scholar
  29. Virchow, R., 1857: Das Hämatom der Dura mater. Verh. phys.-med. Ges. Würzburg 7, 134–142.Google Scholar
  30. Weir, B., 1971: The osmolability of subdural hematoma fluid. J. Neurosurg. 34, 528–533.PubMedCrossRefGoogle Scholar
  31. Weir, B., 1980: Oncotic pressure of subdural fluids. J. Neurosurg. 53, 512–515.PubMedCrossRefGoogle Scholar
  32. Zollinger, R., Gross, R. E., 1934: Traumatic subdural hematoma. An explanation of the late onset of pressure symptoms. J. A.M. A. 103, 245–249.Google Scholar

Copyright information

© Springer-Verlag/Wien 1982

Authors and Affiliations

  • F. Loew
    • 1
  1. 1.Neurosurgical Clinic of the Saarland UniversityHomburg/SaarFederal Republic of Germany

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