PURE SUBDURAL HEMATOMAS OF ARTERIOLAR ORIGIN

Fifteen consecutive cases of subdural haematomas (SDHs) of arteriolar origin operated on during the last twenty years in the Neurosurgical C linic of the University of Genoa are reported. These SDHs are rare and form as a result of a rupture of a cortical arteriolar branch typical ly on the vicinity of the Sylvian fissure. They are always in a pure f orm and never associated with parenchymal lesions. Their aetiology is spontaneous, as in the 40% of our series, or more frequently related t o minor traumas. These SDHs are often encountered in elderly patients generally presenting with severe clinical conditions (in the 60% of ou r patients GCS on admission was < 8). Prompt surgical treatment is req uired in all cases before further worsening of their neurological cond ition, even if CT scanning does not reveal parenchymal lesions. The mo rtality rate is over 50% and mainly relates to the pre-operative GC sc ore. Clinical features, neuroradiological aspects and treatment are di scussed and literature reviewed.