What is a Subdural Hematoma?
A subdural hematoma is a blood clot that develops near the brain. These blood clots are known as subdural hematomas because they form under the dura, which is the protective covering of the brain. Hematomas usually require removal because they can compress the brain tissue and cause life-threatening complications. In some cases, a hematoma can successfully be removed by creating a small perforation in the skull called burr hole drainage. But when the subdural hematoma is larger or more severe, an open surgical procedure known as a craniotomy will be required.
Subdural hematomas may be the result of a significant trauma to the head or of a minor head injury, particularly in those with other risk factors. In patients with a chronic subdural hematoma, the blood clot might form and expand over time, with few if any symptoms initially. Some of the risks for developing a subdural hematoma include older age, use of anticoagulant medications, excessive alcohol consumption and repetitive injuries to the head.
Patients with a subdural hematoma can experience a wide range of symptoms, including headaches, dizziness, weakness, seizures, nausea, sleepiness and behavioral changes. Sometimes, no symptoms are present immediately following the injury and only become noticeable days after the trauma as the hematoma grows.
Diagnosing a Subdural Hematoma
If Dr. Lipani that you have a subdural hematoma, a series of tests may be recommended to confirm a diagnosis. After evaluating your medical history and performing a physical and neurological examination, a CT scan or MRI may be performed to produce internal images of the brain. In some cases, an angiography is performed using dye to highlight blood flow around the brain.
Surgery is usually the most effective approach for the treatment of subdural hematomas that are causing symptoms and are not improving on their own. A craniotomy is a surgical procedure that involves opening up the skull in order to remove the blood clot. An incision is first made in the scalp, then a piece of bone known as a bone flap is removed to access the affected location. Dr. Lipani will remove the subdural hematoma and drain the area without affecting nearby tissue. Once the blood clot has been removed, the skull opening will be closed by replacing and reattaching the bone flap and the scalp incision is sutured.
These procedures are performed under general anesthesia in a hospital setting, and require shaving the scalp in the area where the incision is made. In some cases, patients remain awake during surgery and will be asked to move their leg, repeat the alphabet or tell a story to ensure that brain functioning remains intact during the procedure.
Recovery from a Craniotomy
After a craniotomy procedure, patients will likely experience a headache for a few days, and may feel tired or weak. Most patients will need to spend a few nights in the hospital, but specific recovery times may vary between individuals. Dr. Lipani will prescribe pain medication in order to relieve symptoms and promote efficient healing.
Many of the symptoms typically experienced with a subdural hematoma, such as headaches, balance problems, numbness, weakness and speech issues, are often resolved immediately after the surgery. Some patients require rehabilitation services to restore their previous functionality. In certain cases, seizures may persist for some time after the craniotomy procedure, but can generally be managed by taking anticonvulsant medication prescribed by your physician.
Risks of a Craniotomy
A craniotomy to treat a subdural hematoma is a complex procedure that is not without certain risks and complications. As with any type of surgery, there is a risk of infection and bleeding. After surgery, the brain may swell or an accumulation of fluid may develop that can lead to brain damage and other serious complications. Surgery may also produce some damage in the normal tissue of the brain, which can cause problems with the patient’s ability to think, see or speak.
Dr. Lipani will discuss these risks with you prior to the craniotomy and take precautions to prevent any complications from occurring while performing this procedure.