TLDR;
This video explains chronic subdural hematomas, their causes, symptoms, and treatment options. It details how these hematomas develop from initial bleeding, often due to falls, and how the body's attempt to encapsulate the blood can lead to a cycle of further bleeding and swelling. The video also covers both medical and surgical treatments, including burr hole procedures and craniotomies, while addressing the risk of recurrence and the importance of preventing falls.
- Chronic subdural hematomas are old blood clots under the brain's dura.
- They often result from falls, especially in individuals on blood thinners.
- Treatment ranges from medication to surgery, with craniotomy being a more invasive option.
- A significant risk of recurrence exists post-surgery.
- Preventing falls is crucial in avoiding these hematomas.
Intro [0:00]
The video begins with the speaker mentioning performing two craniotomies for chronic subdural hematomas. He explains that he will describe what a chronic subdural hematoma is, based on his explanations to patients and their families.
What Is It [0:28]
A chronic subdural hematoma is defined as an old blood clot located under the dura, which is the covering of the brain. It forms between the brain and the skull. Typically, it starts with a fall or accident, especially in patients on blood thinners, leading to a small bleed. The body then forms a capsule around the blood in an attempt to resolve it. Subsequent falls or swelling can cause more bleeding and capsule formation, creating a cycle of membrane formation and swelling. This can lead to symptoms like frequent falls, worsening headaches, and general brain dysfunction, prompting a CT scan to reveal the hematoma and its impact on the brain.
Treatment [2:35]
Treatment for subdural hematomas varies depending on the size. Small hematomas can be treated with medication to reduce inflammation and promote absorption. However, surgery is often necessary. Burr hole surgery, which involves drilling one or two holes to drain the fluid, is effective only when there is primarily fluid without significant membrane formation. For more complex cases with substantial membrane formation, a craniotomy is performed. This involves a larger incision to open the skull and peel away the membranes from the brain, removing all the encapsulated material. The speaker likens the appearance of these hematomas to a placenta, with fluid-filled membranes and an outer covering. The speaker shares his experience, noting that the craniotomies took about an hour and a half each, with patients having a drain for a couple of days before being discharged.
Risk [3:54]
A significant problem with surgery for chronic subdural hematomas is the high rate of recurrence. The initial cause of the bleeding may persist, and it's not always possible to remove all membranes due to limited access, even with a large opening in the skull.
Conclusion [4:19]
The best way to prevent chronic subdural hematomas is to prevent falls, especially for those on blood thinners. If symptoms such as headaches, balance issues, or frequent falls occur, it's important to get a scan to determine the cause.
