Editing Subdural hematoma (section)

==Treatment==
Treatment of a subdural hematoma depends on its size and rate of growth. Some small subdural hematomas can be managed by careful monitoring as the [[Thrombus|blood clot]] is eventually resorbed naturally. Others can be treated by inserting a small [[catheter]] through a hole drilled through the skull and sucking out the hematoma.{{citation needed|date=February 2021}}

Large or symptomatic hematomas require a [[craniotomy]]. A surgeon opens the skull and then the dura mater; removes the clot with suction or irrigation; and identifies and controls sites of bleeding.<ref>{{Cite journal |vauthors=Koivisto T, Jääskeläinen JE |date=September 2009 |title=Chronic subdural haematoma – to drain or not to drain? |journal=Lancet |volume=374 |issue=9695 |pages=1040–1041 |doi=10.1016/S0140-6736(09)61682-2 |pmid=19782854 |s2cid=29932520}}</ref><ref>{{Cite journal |display-authors=6 |vauthors=Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ |date=September 2009 |title=Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial |journal=Lancet |volume=374 |issue=9695 |pages=1067–1073 |doi=10.1016/S0140-6736(09)61115-6 |pmid=19782872 |s2cid=5206569}}</ref> The injured vessels must be repaired. Postoperative complications can include increased [[intracranial pressure]], brain [[edema]], new or recurrent bleeding, [[infection]], and [[Epileptic seizure|seizures]]. In patients with a chronic subdural hematoma but no history of seizures, it is unclear whether [[anticonvulsant]]s are harmful or beneficial.<ref>{{Cite journal |vauthors=Ratilal BO, Pappamikail L, Costa J, Sampaio C |date=June 2013 |title=Anticonvulsants for preventing seizures in patients with chronic subdural haematoma |journal=The Cochrane Database of Systematic Reviews |volume=2013 |issue=6 |pages=CD004893 |doi=10.1002/14651858.CD004893.pub3 |pmc=7388908 |pmid=23744552}}</ref>

Those with chronic subudural haematoma (CSDH) with few or no symptoms or have high risk of complication during surgery may be treated conservatively with medications such as atorvastatin, dexamethasone,<ref name="pmid26342776">{{Cite journal |vauthors=Thotakura AK, Marabathina NR |date=December 2015 |title=Nonsurgical Treatment of Chronic Subdural Hematoma with Steroids |journal=World Neurosurgery |volume=84 |issue=6 |pages=1968–1972 |doi=10.1016/j.wneu.2015.08.044 |pmid=26342776}}</ref> and mannitol, although supporting conservative treatment is still weak.<ref name="pmid28102879">{{Cite journal |vauthors=Soleman J, Nocera F, Mariani L |date=2017 |title=The conservative and pharmacological management of chronic subdural haematoma |journal=[[Swiss Medical Weekly]] |volume=147 |pages=w14398 |doi=10.4414/smw.2017.14398 |doi-broken-date=1 November 2024 |pmid=28102879}}</ref> [[HMG-CoA reductase inhibitor]] such as [[Atorvastatin]] can reduce the haematoma volume and improving neurological function in eight weeks.<ref name="pmid30073290">{{Cite journal |display-authors=6 |vauthors=Jiang R, Zhao S, Wang R, Feng H, Zhang J, Li X, Mao Y, Yuan X, Fei Z, Zhao Y, Yu X, Poon WS, Zhu X, Liu N, Kang D, Sun T, Jiao B, Liu X, Yu R, Zhang J, Gao G, Hao J, Su N, Yin G, Zhu X, Lu Y, Wei J, Hu J, Hu R, Li J, Wang D, Wei H, Tian Y, Lei P, Dong JF, Zhang J |date=November 2018 |title=Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients: A Randomized ClinicalTrial |journal=JAMA Neurology |volume=75 |issue=11 |pages=1338–1346 |doi=10.1001/jamaneurol.2018.2030 |pmc=6248109 |pmid=30073290}}</ref> HMG-CoA reductase inhibitor may also reduce risk of recurrences in CSDH.<ref name="pmid27695533">{{Cite journal |vauthors=Yadav YR, Parihar V, Namdev H, Bajaj J |date=2016 |title=Chronic subdural hematoma |journal=Asian Journal of Neurosurgery |volume=11 |issue=4 |pages=330–342 |doi=10.4103/1793-5482.145102 |pmc=4974954 |pmid=27695533 |doi-access=free}}</ref> Dexamethasone, when used together with surgical drainage, may reduce the recurrence rate of subdural haematoma.<ref>{{Cite journal |vauthors=Chan DY, Sun TF, Poon WS |date=December 2015 |title=Steroid for chronic subdural hematoma? A prospective phase IIB pilot randomized controlled trial on the use of dexamethasone with surgical drainage for the reduction of recurrence with reoperation |journal=Chinese Neurosurgical Journal |language=en |volume=1 |issue=1 |pages=2 |doi=10.1186/s41016-015-0005-4 |issn=2057-4967 |s2cid=3934313 |doi-access=free}}</ref> Even with surgical evacuation of chronic subdural haematoma, the recurrence rate is high, ranging from 7 to 20%.<ref name="pmid28102879" />