ACUTE SUBDURAL-HEMATOMA - NONSURGICAL MANAGEMENT OF SELECTED PATIENTS

There is a current trend toward nonsurgical therapy for small, minimal ly symptomatic acute subdural hematomas (ASDH), but data supporting su ch a scheme have been lacking. We evaluated 83 patients with minimally symptomatic ASDH (Glasgow Coma Scale scores of 11-15) and found 58 ma naged nonsurgically (70%) and 25 managed with craniotomy (30%). Patien ts managed without surgery had a lower incidence of focal neurologic d eficits (12% vs. 40%; p <.01), open cisterns (90% vs. 28%; p < .001), and small (less-than-or-equal-to 1 cm) ASDHs (92% vs. 62%; p < .001). Ninety-three percent of patients managed nonsurgically had functional recovery compared with 84% of patients with craniotomy. Age and Injury Severity Score were significantly associated with patient outcome. Ti ming of surgery had no association with outcome. Six percent of patien ts managed nonsurgically developed chronic SDH requiring craniotomy. W e conclude that unless the hematoma is causing clinical evidence of in tracranial hypertension or significant neurologic dysfunction, there a ppears to be no advantage in evacuating the clot. Selected patients wi th ASDH and GCS scores of 11-15 can safely be managed without cranioto my.