Chronic Subdural Hematoma · Observe vs Burr-Hole Drainage

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Symptoms + thickness/midline shift
   Symptomatic? Hematoma thickness/midline shift? Acute deterioration?
   • Symptomatic (headache/focal/cognitive) or large thickness/marked midline shift → Symptomatic/thick → burr-hole drainage
   • Asymptomatic, thin, no significant mass effect → Asymptomatic thin → observe
   • Acute deterioration/herniation → Acute deterioration/herniation → emergency evacuation
2. [End] Asymptomatic thin → observe
   Asymptomatic, thin (generally <10 mm), no significant midline shift → observe + repeat CT; assess stopping antithrombotics; some resorb; atorvastatin/dexamethasone evidence is limited.
3. [End] Symptomatic/thick → burr-hole drainage
   Symptomatic or large thickness/midline shift → burr-hole drainage + closed drainage (lowers recurrence); middle meningeal artery (MMA) embolization as an adjunct/for high recurrence.
4. [End] Acute deterioration/herniation → emergency evacuation
   Acute deterioration/herniation → emergency surgical evacuation (burr hole/craniotomy); correct coagulopathy.

Source guidelines & references

• Chronic subdural hematoma management (burr-hole drainage; MMA embolization adjunct)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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