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Criteria for conservative treatment of supratentorial acute subdural haematomas

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Summary

Without mortality, 31 patients underwent conservative treatment for traumatic supratentorial acute subdural haematoma (SDH). Later on six of them had the haematoma surgically evacuated mainly because of a deterioration of the Glasgow Coma Scale (GCS) scores.

It was found that patients with a midline shift of less than 10 mm on the computed tomography (CT) scans and with a GCS score of 15 initially might be treated conservatively under close observation, reserving urgent craniotomy and evacuation of the SDH for those with deteriorating neurological conditions. A smaller degree of midline shift was tolerated by patients with an GCS score of less than 15: a shift of more than 5 mm on the initial CT scans predicted an exhaustion of the cerebral compensatory mechanism within 3 days of injury. In such cases the GCS score worsened, and surgical evacuation of the SDH became necessary.

A total hospital stay of 6 to 7 days may suffice for those who have become fully conscious. Repeat CT studies before discharge should be done and a close follow-up during the first 3 to 4 weeks is advisable.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan, Republic of China

    Ch. W. Wong

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  1. Ch. W. Wong
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Wong, C.W. Criteria for conservative treatment of supratentorial acute subdural haematomas. Acta neurochir 135, 38–43 (1995). https://doi.org/10.1007/BF02307412

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