DOI: https://doi.org/10.22263/2312-4156.2026.3.60
Y.O. Ryabchikova1, Y.G. Shanko2
Efficiency of conservative therapy and combined approaches in the treatment of chronic subdural hematomas: comparative study results
1Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus
25th City Clinical Hospital, Minsk, Republic of Belarus
Vestnik VGMU. 2026;25(3):60-72.
Abstract.
Chronic subdural hematoma (CSDH) is a common neurosurgical condition in the elderly. This article presents the clinical presentation, diagnostic results, and treatment of CSDH.
Objectives. To substantiate the effectiveness of conservative therapy (alone and combined with surgical treatment) in patients with CSDH, determine its advantages in reducing complications, relapses and the surgical and intensive care unit workload, and study the clinical features and prospects for patient management.
Material and methods. The study (November 2021 – December 2025) included 168 patients with CSDH. In group 1 (n=53) surgery without pathogenetic therapy was carried out. In group 2 (n=64) the endoscopically guided surgery was performed combined with specialized conservative therapy. In group 3 (n=51) only the specialized conservative therapy was applied. All patients were assessed using accepted clinical and instrumental examination methods.
Results. Neurological manifestations varied: pyramidal hemisyndrome prevailed in the surgical groups, while ataxia was present in the therapeutic group. The change in the volume of CSDH after treatment decreased: in group 2 – by 6.1 times, in group 1 – by 1.5, in group 3 – by 5.3 (differences between groups 2 and 3 are significant). According to the Glasgow Outcome Scale, groups 2 and 3 showed an advantage over group 1. Good recovery: group 3 – 100%, group 2 – 93.8% (p=0.262), group 1 – 56.6% (p=0.001). Mortality: group 1 – 17%, group 2 – 3.1%, group 3 – 0% (p=0.002 for 1 vs 3, p=0.203 for 2 vs 3). Postoperative mortality was 15% and 2.9%, respectively.
Conclusions. The performed comparison of the clinical material results demonstrated a new possibility of successful treatment of CSDH using the method of conservative therapy and its combination with surgical methods. Therapeutic treatment of CSDH in clinically compensated patients is an alternative to surgery, allowing for the avoidance of postoperative complications and relapses and reducing the surgical and intensive care unit workload of a medical institution.
Keywords: chronic subdural hematoma, pathophysiology of chronic subdural hematoma, endoscopically controlled surgical treatment, conservative treatment.
References
1. Potapov AA, Likhterman LB, Kravchuk AD. Chronic subdural hematomas. Moscow, RF: Antidor; 1997. 231 р. (In Russ.).
2. El-Kadi H, Miele VJ, Kaufman HH. Prognosis of Chronic Subdural Hematomas. Neurosurgery Clinics of Nord America. 2000;11(3):553-557.
3. Konovalov AN, Potapov AA, Likhterman LB, Kornienko VN, Kravchuk AD, Okhlopkov VA, i dr. Reconstructive and minimally invasive surgery for the consequences of brain injury. Moscow, RF: Antidor; 2012. 320 р. (In Russ.).
4. Markwalder T, Seilor R. Chronic subdural hematoma: to drain or not drain? Neurosurgery. 1985 Feb;16(2):185-188. doi: http://dx.doi.org/10.1227/00006123-198502000-00010
5. Kuwamura K, Kudoh H, Tomita H. Epidemiologic aspect of chronic subdural hematoma. In: Nakamura N, Hashimoto T, ed. Recent advancesin neurotraumatology. Tokyo: Springer; 1993. P. 450-452.
6. Clinical practice guidelines for the care of patients with a chronic subdural haematoma: multidisciplinary recommendations from presentation to recovery / D. J. Stubbs, B. M. Davies, E. Edlmann [et al.] // British journal of neurosurgery. 2026 Feb. Vol. 40, № 1. P. 94–103. doi: http://dx.doi.org/10.1080/02688697.2024.2413445
7. Feghali J, Yang W, Huang J. Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment and Outcome. World Neurosurgery. 2020 Sep. Vol. 141. P. 339-345. doi: http://dx.doi.org/10.1016/j.wneu.2020.06.140
8. Stubbs DJ, Vivian ME, Davies BM, Ercole A, Burnstein R, Joannides AJ. Incidence of chronic subdural haematoma: a single-centre exploration of the effects of an ageing population with a review of the literature. Acta neurochirurgica. 2021 Sep;163(9):2629-2637. doi: http://dx.doi.org/10.1007/s00701-021-04879-z
9. Zolfaghari S, Bartek J Jr, Strom I, Djärf F, Wong SS, Ståhl N, et al. Burr hole craniostomy versus minicraniotomy in chronic subdural hematoma: a comparative cohort study. Acta Neurochirurgica. 2021 Nov;163(11):3217-3223. doi: http://dx.doi.org/10.1007/s00701-021-04902-3
10. Lin JJ, Chang DC. Tremor caused by ipsilateral chronic subdural hematoma. Journal of Neurosurgery. 1997;87(3):474. doi: http://dx.doi.org/10.3171/jns.1997.87.3.0474
11. Adhiyaman V, Chattopadhyay I, Irshad F, Curran D, Abraham S. Increasing incidence of chronic subdural haematoma in the elderly. QJM. 2017 Jun;110(6):375-378. doi: http://dx.doi.org/10.1093/qjmed/hcw231
12. Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. Journal of Neuroinflammation. 2017 May;14(1):108. doi: http://dx.doi.org/10.1186/s12974-017-0881-y
13. Holl DC, Volovici V, Dirven CMF, Peul WC, van Kooten F, Jellema K, et al. Pathophysiology and nonsurgical treatment of chronic subdural hematoma: from past to present to future. World Neurosurg. 2018 Aug;116:402-411. doi: http://dx.doi.org/10.1016/j.wneu.2018.05.037
14. Huang J, Gao C, Dong J, Zhang J, Jiang R. Drug treatment of chronic subdural hematoma. Expert Opin Pharmacother. 2020 Mar;21(4):435-444. doi: http://dx.doi.org/10.1080/14656566.2020.1713095
15. Soleman J, Nocera F, Mariani L. The conservative and pharmacological management of chronic subdural haematoma. Swiss Medical Weekly. 2017 Jan;147:w14398. doi: http://dx.doi.org/10.57187/smw.2017.14398
16. Fu S, Li F, Bie L. Drug therapy for chronic subdural hematoma: bench to bedside. Journal of Clinical Neuroscience. 2018 Oct;56:16-20. doi: http://dx.doi.org/10.1016/j.jocn.2017.07.034
17. Mehta V, Harward SC, Sankey EW, Nayar G, Codd PJ. Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. Journal of Clinical Neuroscience. 2018 Apr;50:7-15. doi: http://dx.doi.org/10.1016/j.jocn.2018.01.050
18. Motoie R, Karashima S, Otsuji R, Ren N, Nagaoka S, Maeda K, et al. Recurrence in 787 patients with chronic subdural hematoma: Retrospective cohort investigation of associated factors including direct oral anticoagulant use. World Neurosurgery. 2018 Oct;118:e87-e91. doi: http://dx.doi.org/10.1016/j.wneu.2018.06.124
19. Wan KR, Qiu L, Saffari SE, Khong WXL, Ong JCL, See AA, et al. An open label randomized trial to assess the efficacy of tranexamic acid in reducing post-operative recurrence of chronic subdural haemorrhage. Journal of Clinical Neuroscience. 2020 Dec;82(Pt A):147-154. doi: http://dx.doi.org/10.1016/j.jocn.2020.10.053
20. Tanweer O, Frisoli FA, Bravate C, Harrison G, Pacione D, Kondziolka D, et al. Tranexamic acid for treatment of residual subdural hematoma after bedside twist-drill evacuation. World Neurosurgery. 2016 Jul;91:29-33. doi: http://dx.doi.org/10.1016/j.wneu.2016.03.062
21. Shanko OG, Ryabchikova YuO, Parkhach LP. Conservative treatment method for patients with chronic traumatic and non-traumatic subdural hemorrhage: instruktsiya po primeneniyu № 050-1025: utv. 12.12.2025 g. Minsk, RB; 2025. 8 р. (In Russ.).
22. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery. 2007 Oct;61(4):794-797. doi: http://dx.doi.org/10.1227/01.NEU.0000298908.94129.67
23. Berghauser Pont LM, Dirven CM, Dippel DW, Verweij BH, Dammers R. The role of corticosteroids in the management of chronic subdural hematoma: a systematic review. European Journal of Neurology. 2012 Nov;19(11):1397-403. doi: http://dx.doi.org/10.1111/j.1468-1331.2012.03768.x
24. Kageyama H, Toyooka T, Tsuzuki N, Oka K. Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. Journal of Neurosurgery. 2013 Aug;119(2):332-337. doi: http://dx.doi.org/10.3171/2013.3.JNS122162
25. Yun HJ, Ding Y. How to remove those bloody collections: Nonsurgical treatment options for chronic subdural hematoma. Brain Circulation. 2020 Dec;6(4):254-259. doi: http://dx.doi.org/10.4103/bc.bc_73_20
26. Yang K, Kim KH, Lee HJ, Jeong EO, Kwon HJ, Kim SH. Role of adjunctive tranexamic acid in facilitating resolution of chronic subdural hematoma after surgery. Journal of Korean Neurosurgical Society. 2023 Jul;66(4):446-455. doi: http://dx.doi.org/10.3340/jkns.2022.0200
Submitted 05.05.2026
Accepted 19.06.2026
Information about authors:
Yulia O. Ryabchikova – neurosurgeon of the Neurosurgical Department, Vitebsk Regional Clinical Hospital, post-graduate of the Republican Scientific and Practical Centre of Neurology and Neurosurgery, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.;
Y.G. Shanko – Doctor of Medical Sciences, professor, corresponding member of NAS of Belarus, head of the Department of Neurology and Neurosurgery, 5th City Clinical Hospital, Minsk.
