What Is a Subdural Hematoma?
A subdural hematoma is a common neurological condition that occurs after a head injury. It occurs when blood builds up between the outermost covering of the brain (the dura) and the brain itself.
Our neurosurgeons specialize in traditional surgery techniques and minimally invasive procedures such as middle meningeal artery (MMA) embolization. We use MMA embolization as an alternative to brain surgery for some patients. At University of Utah Health, we provide our subdural hematoma patients with exceptional care and support every step of the way.
Types of Subdural Hematomas
Acute Subdural Hematoma
Acute subdural hematomas usually occur because of a head injury. In cases that need immediate treatment, patients will undergo traditional surgery in which a portion of the skull is removed, the outermost covering of the brain (the dura) is opened, and the acute subdural hematoma is evacuated.
Most cases, however, do not require treatment. Instead, patients are admitted to the hospital, where a multi-disciplinary care team will observe the hematoma to make sure it does not worsen over time and ensure that the patient is able to get back on their feet. This type of subdural hematoma typically goes away on its own over the span of a few weeks.
Chronic Subdural Hematoma
A chronic (non-acute) subdural hematoma is a commonly encountered problem, particularly in older adults. It often forms due to an acute subdural hematoma that will not go away. Instead of breaking down, the blood will form membranes and tiny blood vessels within the membranes that attract water and ooze. This causes the blood to expand and form a gelatin-like substance that does not resolve on its own.
Subdural Hematoma Symptoms
The most common symptoms of acute and chronic subdural hematomas include:
- headache,
- confusion,
- changes in behavior,
- dizziness,
- nausea and vomiting,
- fatigue,
- weakness on one side of the body,
- difficulty with walking,
- disinterest in normal activities, and
- seizures.
These symptoms may appear immediately after a head injury or develop over time. Some people will not experience any symptoms for several weeks. Frequently, in patients who have chronic (non-acute) subdural hematomas, they may not even remember experiencing a head injury in the past.
Diagnosing Acute & Chronic Subdural Hematomas
When doctors suspect that a patient may have a subdural hematoma, they use a computed tomography (CT) scan of the head to make a definite diagnosis. A CT scan combines a series of X-ray images taken from different angles and uses computer software to create cross-sectional images (slices) of the bones and brain tissue.
When a patient has a chronic (non-acute) subdural hematoma that requires treatment, our neurosurgeons frequently use magnetic resonance imaging (MRI) to help predict which treatment strategy will be most effective. MRI uses a strong magnetic field and radio waves to create detailed images of the brain tissues. The use of MRI allows our neurosurgeons to recommend the treatment that is most likely to lead to long-term cure of the subdural hematoma with the lowest likelihood of returning in the future.
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Subdural Hematoma Treatment
People with an acute subdural hematoma typically do not need treatment because the hematoma will break down in the body over time. However, in some cases, following a head injury, an acute subdural hematoma will need to be treated immediately with surgery to relieve pressure on the brain.
Treatment options for chronic (non-acute) subdural hematomas include the following:
- Medication—This may help resolve the subdural hematoma.
- Brain surgery (craniotomy)—This is a surgical procedure that opens the skull to remove the subdural hematoma.
- Middle meningeal artery (MMA) embolization—which involves guiding a catheter into an artery that is supplying blood to the subdural hematoma and releasing specialized pellets to stop the bleeding.
Chronic subdural hematomas, in particular, can be complicated and may recur after surgery. Some patients may need a combination of MMA embolization, surgery, and medication. Your neurosurgeon will discuss your options and recommend a personalized treatment plan to ensure the best outcome for your health.
Brain Surgery
We may need to treat some chronic subdural hematomas with brain surgery to drain the blood that has collected between the brain and the dura (outermost covering of the brain).
For some patients, surgery may be performed under sedation in our Neurocritical Care Unit. In these cases, your neurosurgeon will numb up your skin with local anesthetic and make a small 1-inch incision (cut) in your scalp. He or she will drill a tiny hole into your skull and insert a device called a subdural evacuating port system to gently drain the blood out.
For brain surgeries in the operating room, your neurosurgeon will put you to sleep under general anesthesia. Your neurosurgeon will either create small holes in your skull or remove a piece of your skull (which will be replaced after surgery) to insert a drain into the chronic subdural hematoma. The subdural hematoma will gently drain away within two to four days.
Middle Meningeal Artery (MMA) Embolization
MMA embolization is a minimally invasive, non-surgical procedure that takes place in our state-of-the-art Neurointerventional Radiology Suite. It takes about 30 minutes and typically requires light sedation, not general anesthesia that puts you to sleep.
Your surgeon will insert a catheter (a thin, flexible tube) into an artery in your thigh and thread it into the middle meningeal artery — an artery that runs within the leathery covering of the brain, called the dura. This artery is responsible for supplying blood to the chronic subdural hematoma.
Next, your surgeon will insert an embolic agent (used to block blood flow) through the catheter. This substance will be pushed all the way into the middle meningeal artery until it reaches the subdural hematoma and cuts off the blood supply to the hematoma. This allows the body to break down the chronic subdural hematoma on its own within the following days and weeks.
Advantages of MMA Embolization
As a non-surgical alternative, undergoing MMA embolization includes shorter hospital stays and a faster recovery. This is commonly used as a stand-alone treatment for a patient with a chronic subdural hematoma. In some cases, your neurosurgeon may recommend MMA embolization as a follow-up therapy if initial brain surgery for the chronic subdural hematoma was not successful. This has been shown to decrease the risk of a recurring hematoma and decrease the chances of needing another operation to re-drain it.
Chronic Subdural Hematoma Prognosis
With effective treatment, the vast majority of chronic subdural hematomas will go away for patients. Many patients will also notice a reduction in symptoms such as decreased headaches, improved walking, and more energy. After the initial treatment, your neurosurgeon will conduct follow-up testing. If the hematoma returns or remains in your brain, your doctor will discuss additional treatment options and next steps with you.
Make an Appointment with Our Neurosurgeons
Our neurosurgeons have extensive training and experience in treating people with acute and chronic subdural hematomas. If you would like to see one of our specialists, please call 801-585-6065 or request an appointment online. Physician referrals are welcome but not necessary.
Hear From Our Patients
Judd Jones, an active 83-year-old business owner, was taking a shower when he slipped and fell and hit his head. More than a month later, he was working in the yard when one of his arms, neck, and back started to tingle. However, it went away. The following day, he experienced the same numbness and tingling and started "speaking gibberish." His wife took him to the emergency room. The doctors diagnosed him with a chronic subdural hematoma, most likely caused by his fall in the shower weeks prior.