硬膜下血肿

A subdural hematoma is a collection of blood that gathers between the skull and the surface of the brain, usually after a head injury, and this pooled blood presses on the brain. It can develop quickly (hours) or slowly (days to weeks), and the seriousness depends on how much blood collects and how fast.​

1) What is this condition?

  • It is a pocket of blood trapped between the outer covering of the brain and the brain itself.​

  • Often caused by torn veins from a fall, car crash, or even a minor bump in older adults or those on blood thinners.​

  • Symptoms can include headache, confusion, sleepiness, weakness, speech changes, or seizures.​

2) How serious is it?

  • Acute (sudden) subdural hematomas are medical emergencies and can be life‑threatening if not treated quickly.​

  • Chronic (slow‑developing) ones may start with mild symptoms but can still lead to serious problems if the blood continues to build up.​

  • Risk is higher in older adults, people on blood thinners, and those with severe brain injury or other health problems.​

3) Non‑surgical treatments

  • Careful hospital observation for small, stable collections with mild or no symptoms, including repeat brain scans.​

  • Stopping or reversing blood‑thinning medicines (like warfarin or some antiplatelets) when safe.​

  • Medicines for headaches, seizures, and to control brain swelling in selected cases.​

  • For chronic subdural hematomas with very mild symptoms, “watch and wait” alone can succeed in about two‑thirds of patients.​

4) Types of surgery that may be needed

  • Burr hole drainage: one or more small holes are drilled in the skull, and a tube is placed to drain the blood.​

  • Craniotomy (larger opening): a bigger piece of bone is temporarily removed so the surgeon can remove thicker or more complex clots.​

  • In some chronic cases, a small “minicraniotomy” or twist‑drill bedside drain may be used.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Let the body slowly reabsorb small, stable blood collections while avoiding the risks of surgery.​

    • Prevent expansion by adjusting blood thinners and treating any underlying problems.​

  • Surgery goals:

    • Remove the blood to relieve pressure on the brain and prevent further damage.​

    • Improve or reverse symptoms like weakness, confusion, and trouble walking.​

6) How surgery can “fix” the problem

  • Draining the blood creates more room in the skull so the brain is no longer squeezed.​

  • With burr holes, the now‑thinner, older blood (in chronic cases) can slowly drain out through a tube over hours to days.​

  • With craniotomy, thicker, clotted blood and any dividing membranes can be removed more completely when needed.​

7) Risks of surgery (general and specific)

  • General risks: bleeding, infection, blood clots, and anesthesia problems.​

  • Specific to subdural surgery:

    • Re‑accumulation (recurrence) of the blood, sometimes needing another operation.​

    • Brain swelling, new bleeding, stroke, or seizures.​

    • Fluid buildup or long‑term drainage issues if a drain or shunt is placed.​

8) Chances this surgery will work

  • For chronic subdural hematomas, most patients improve after surgery, with many reporting better headaches, walking, and energy.​

  • Burr hole drainage generally has high success, lower re‑operation rates, and shorter hospital stays than full craniotomy for many chronic cases.​

  • Outcomes are less predictable in very frail patients, those with severe brain injury, or large acute bleeds, but surgery can still be life‑saving.​

9) Possible complications from the surgery

  • Recurrence of the hematoma, requiring repeat drainage (rates vary but often around 5–20%, depending on technique and patient factors).​

  • Infections (wound or deeper brain coverings), seizures, or strokes after surgery.​

  • Persistent weakness, balance problems, or thinking changes, especially in older adults or those with underlying brain disease.​

10) Typical recovery from the condition

  • In chronic cases, many people notice symptom relief (less headache, better walking, more alertness) over days to weeks after successful treatment.​

  • Full recovery of strength and balance can take weeks to months, and some may not return all the way to their previous level.​

  • Fatigue, mild memory issues, or mood changes may linger and sometimes need rehabilitation or support.​

11) Typical recovery after surgery

  • First days: close monitoring in the hospital while the drain (if placed) stays in, with frequent checks of strength, speech, and alertness.​

  • First weeks: gradual increase in walking and activity; many patients can return to light daily tasks fairly quickly if there are no major complications.​

  • By about 3–12 months, most people who had chronic subdural surgery and were relatively healthy before can resume exercise and usual activities, though some need ongoing therapy.​

12) How long in the hospital

  • Many patients having burr hole drainage stay in the hospital around 3–7 days, depending on age, other illnesses, and complications.​

  • Craniotomy or more complex cases may require longer stays and sometimes transfer to a rehab facility before going home.​

13) Long‑term outlook

  • With effective treatment, the vast majority of chronic subdural hematomas resolve and symptoms improve significantly.​

  • Long‑term survival is often more influenced by age and other health conditions than by the hematoma itself.​

  • A small group experience recurrences or lasting disability, especially very elderly or medically fragile patients.​

14) Need for outpatient follow‑up

  • Follow‑up visits check symptoms, wound healing, and any seizure or medication issues.​

  • Repeat brain scans are usually done to confirm that the blood has gone away and has not come back.​

  • Some people need physical, occupational, or speech therapy, plus guidance on fall prevention and safe return to driving or work.