Open Access Maced J Med Sci. 2021 Jul 26; 9(B):779-785. 779 Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2021 Jul 26; 9(B):779-785. https://doi.org/10.3889/oamjms.2021.6566 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Surgery Delayed Treatment of Acute Subdural Hematomas: Retrospective Outcome Analysis of 215 Patients Kanat Akhmetov 1,2 , Serik Akshulakov 2 , Yerzhan Adilbekov 2 , Altynshash Jaxybayeva 1 , Mariya Dmitriyeva 3 * , Medet Toleubayev 3,4 1 Department of Neurology, Astana Medical University, Nur-Sultan, Kazakhstan; 2 Department of Neurosurgery, National Center for Neurosurgery, Nur-Sultan, Kazakhstan; 3 Department of General and Plastic Surgery, Astana Medical University, Nur-Sultan, Kazakhstan; 4 Department of Surgery, Multidisciplinary City Hospital, Nur-Sultan, Kazakhstan Abstract BACKGROUND: The preferred treatment method for acute subdural hematoma (aSDH) is surgical intervention. AIM: We aimed to show that, regardless of the good results of surgical treatment, conventional delayed treatment might be very useful in some situations and might lead to chronicity of hematoma as well as reduction of surgical intervention scope and reduce risk of anesthesia. It might also give rise to spontaneous resorption of hematoma. METHODS: In the period March 1, 2013–March 1, 2020, we retrospectively examined 215 aSDH patients. The basic result of the outcome analysis was evaluated on the basis of the Glasgow Outcome Scale (GOS) at discharge after 3-month and 6-month follow-up. RESULTS: A total of 215 patients with aSDH and minor or moderate brain injury were examined, while applying conventional delayed treatment, the following results were obtained: large craniotomy was carried out in 123 patients (57.2%) on the 2 nd –3 rd day of observation, small craniotomy with drainage was applied in 29 patients (13.5%) and spontaneous resorption of subdural hematoma occurred in 63 patients (29.3%). The median score as per the Glasgow Coma Scale at admission to the hospital was 11.4. CONCLUSION: This study showed that conventional delayed treatment applied in patients with aSDH and minor or moderate craniocerebral injury might lead to chronicity and resorption of aSDH. The outcomes as per the GOS scale also showed good data three and 6 months after hospitalization. Edited by: Ksenija Bogoeva-Kostovskai Citation: Akhmetov K, Akshulakov S, Adilbekov Y, Jaxybayeva A, Dmitriyeva M, Toleubayev M. Delayed Treatment of Acute Subdural Hematomas: Retrospective Outcome Analysis of 215 Patients. Open Access Maced J Med Sci. 2021 Jul 26; 9(B):779-785. https://doi.org/10.3889/oamjms.2021.6566 Keywords: Acute subdural hematoma; Conventional delayed treatment; Nonsurgical treatment *Correspondence: Mariya Dmitriyeva, Department of General and Plastic Surgery, Astana Medical University, Nur-Sultan, Kazakhstan. E-mail: dmitriyeva.m@amu.kz Received: 03-Jun-2021 Revised: 21-Jun-2021 Accepted: 16-Jul-2021 Copyright: © 2021 Kanat Akhmetov, Serik Akshulakov, Yerzhan Adilbekov, Altynshash Jaxybayeva, Mariya Dmitriyeva, Medet Toleubayev Funding: This research did not receive any fnancial support Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Acute traumatic subdural hematoma (aSDH) is observed in 12–29% of patients with craniocerebral injury (CCI) or craniocerebral trauma [1]. aSDH patients are often in a bad neurological state assessed with a score of 8 according to the Glasgow Coma Scale (GCS). Although the aSDH course largely varies, based on GCS, the death rate ranges from 30% to 60% in all aSDH patients and from 55% to 70% in patients with 8 or lesser score [2], [3], [4]. aSDH usually develops right after a severe injury, for example, after a trafc accident or after falling from a height; as a rule, aSDH presence and growth might elevate intracranial pressure to a dangerous level, leading to lethal outcomes [5], [6]. Current guiding principles prescribe urgent surgical treatment to patients who have 10 mm or wider hematoma or 5 mm or more midline shift shown on computerized tomography (CT) or to those who have intracranial pressure exceeding 20 mm Hg; these principles prescribe craniotomy with the removal of hematoma [7], [8], [9]. Based on research, it is apparent that the conventional treatment for aSDH might be used in some cases. Conventional delayed treatment is applied to asymptomatic hematomas, to patients refusing surgery, or to patients with high surgical risk. Any changeable factor that might help in ensuring a better post-surgical treatment result should be studied. A delayed surgical invasion will allow an acute clot to become a chronic one, delayed intervention would allow for acute clot to become chronic subsequently allowing for a smaller incision, smaller craniotomy (bure hole), less blood loss, and duration of anesthesia. A small craniotomy will ensure lesser blood loss and shorter anesthesia duration, thereby improving the outcome and reducing mortality [10]. Moreover, the delay might lead to spontaneous resorption of aSDH. To date, there is no consensus about the best treatment, as the treatment technique should be customized for each patient. Patients with symptoms and confrmed X-ray identifcation of hematomas are usually treated surgically, whereas patients with asymptomatic hematomas and small hematomas not taking a large space may be treated conventionally by means of medication or thorough observation. In this series, we report the case of 215 patients with aSDH surgical diagnosis and minor or moderate CCI who