Asymptomatic chronic subdural haematoma - does it need neurosurgical intervention?

Parry, Daniel, Baskaran, Ravanth, Lima, Ashleigh, Dagnan, Richard, Jaber, Hisham, Manivannan, Susruta and Zaben, Malik ORCID: https://orcid.org/0000-0002-7446-4532 2023. Asymptomatic chronic subdural haematoma - does it need neurosurgical intervention? British Journal of Neurosurgery 39 (2) , pp. 204-209. 10.1080/02688697.2023.2210224

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Abstract

Purpose Chronic subdural haematoma (CSDH) is a well-recognized consequence of head injury with a rising incidence worldwide. Whilst symptomatic CSDH warrants consideration of surgical intervention, the management of asymptomatic CSDH (AsCSDH) remains unclear. In this retrospective study, we investigate the natural history of AsCSDH, the requirement for radiological monitoring, and the role of neurosurgical input. Methods Head injury referrals to a tertiary neurosurgical unit over two years were screened to identify patients with AsCSDH. Clinical, radiological, and outcome parameters were collected for included patients. Results Of 2725 referrals, 106 (3.9%) patients were eligible for inclusion. The cohort consisted of predominantly male patients (70.8%) with an average age of 81.9 years and independent at baseline (79.3%). Radiological follow-up was recommended by neurosurgery in 4 patients (3.8%). Medical teams performed follow-up imaging for 57 patients (53.8%) culminating in a total of 116 follow-up scans, predominantly for falls or monitoring purposes. Antithrombotic agents were used by 61 patients (57.5%). Anticoagulants were held in 26/37 patients (70.3%) and antiplatelets in 12/29 patients (41.4%), ranging from 7 to 16 days when specified. Only one patient required neurosurgical intervention at 3 months from the time of initial presentation after the development of symptoms. Conclusions Patients with AsCSDH do not require neuroradiological follow-up or neurosurgical intervention in the majority of instances. Medical professionals should explain to patients, families, and caregivers that the isolated finding of CSDH is not necessarily a cause for concern but safety netting advice regarding AsCSDH should be provided.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Publisher:	Taylor and Francis Group
ISSN:	0268-8697
Date of Acceptance:	30 April 2023
Last Modified:	01 Apr 2025 13:45
URI:	https://orca.cardiff.ac.uk/id/eprint/177315

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