When is surgical evacuation indicated for a chronic subdural hematoma?

Surgical evacuation for a chronic subdural hematoma is indicated particularly when significant cognitive impairment is noted or if there is progressive neurologic deterioration. This is because chronic subdural hematomas can lead to increased intracranial pressure and may compromise brain function, especially in older adults or those with pre-existing neural conditions. When a patient displays moderate to severe cognitive impairment, or shows signs of worsening neurological status, this often signifies that the hematoma is having a detrimental effect on brain function, necessitating intervention.

Timely surgical evacuation can alleviate these symptoms and potentially restore function, making it a critical decision point in management. The absence of recovery potential, a smaller clot size, or signs of infection do not necessarily warrant immediate surgical intervention as much as the presence of cognitive deficits and neurologic decline, which directly impact the patient’s overall functioning and quality of life.