Management of Chronic Subdural Hematoma: Part II—Treatment and Prognosis

Chronic subdural hematoma (CSDH) is a common condition in neurosurgical practice. In part I of this review, we discussed the pathophysiology and diagnosis of CSDH. In this part II, we present treatment options and the most important determinants of disease outcome. From 1883 onward, patients have been treated for CSDH using craniotomy, which was fi rst described by Hulke. It took until 1925 before surgical treatment became a cornerstone in the treatment of CSDH. In 1937, description of burr-hole craniostomy (BHC) and irrigation with saline was published for the fi rst time by Horrax and Poppen. This contributed to the acceptance of this treatment and the adaptation of BHC as a fi rst-choice treatment. In 1958, Ambrosetto was the fi rst to report the curative potential of corticosteroids. Until now, however, there has been no consensus about which treatment of CSDH is optimal for each patient. The most commonly used treatments are BHC, twistdrill craniostomy (TDC), craniotomy, and conservative treatment with or without medication such as corticosteroids. Table 1 provides an overview of the various treatment options.