Subdural Hematoma Specialist in Los Angeles

A subdural hematoma is a collection of blood between the dura mater (the brain’s outer covering) and the surface of the brain. It’s typically caused by a head injury that tears bridging veins, causing blood to leak and build pressure on the brain. Subdural hematomas can develop quickly after a severe trauma or slowly over days or weeks, often after a minor head bump (especially in older adults or those on blood thinners). By working with a leading brain surgeon in Los Angeles, patients can receive a treatment plan built around their individual case.Symptoms vary based on the size and speed of bleeding but can include headache, confusion, dizziness, nausea, drowsiness, weakness on one side of the body, or loss of consciousness. Diagnosis is usually made with a CT scan.

Subdural Hematoma Treatment Options

For small hematomas, treatment often involves just monitoring. For larger ones, surgical intervention is needed to relieve pressure on the brain.

Observation and Monitoring

Small subdural hematomas with minimal symptoms may not require immediate surgery.

Some factors that may point to such a conservative approach include:

  • Small hematoma on CT or MRI
  • No significant pressure on the brain
  • Stable neurological exam
  • Mild or no symptoms

Neurological monitoring and CT or MRI scans form the core of tracking your condition. Blood pressure should also be monitored. You may also need to pause blood-thinning medications. Ideally, the subdural hematoma will stabilize and slowly resolve.

Burr Hole Drainage

Hospital Stay: 1–3 days Burr hole draining serves as the most common surgical treatment for subdural hematoma. The procedure involves drilling one or two small holes into the skull. The accumulated blood is then drained to relieve pressure. When appropriate, a temporary draining tube may be placed for up to 48 hours.

Advantages:

  • Minimally invasive
  • Short surgical time
  • Often performed under general or local anesthesia
  • High success rate for chronic hematomas

Craniotomy

Hospital Stay: 3–7 days A craniotomy is reserved for larger or acute hematomas that cause significant brain compression. The procedure involves temporarily removing a small section of the skull, followed by direct removal of the clot. Any vessels contributing to bleeding are identified and controlled. Afterward, the bone flap is replaced and secured.

Indications:

  • Acute traumatic subdural hematoma
  • Large blood clot
  • Significant midline brain shift
  • Rapid neurological decline

Decompressive Craniectomy

When patients have severe, dangerous brain swelling, Dr. Sarkiss may recommend a craniectomy. A larger portion of the skull is removed compared to craniotomy. However, this extra amount allows the brain to swell without causing fatal pressure. From there, the swelling may resolve on its own, or craniotomy may be performed. Afterward, the skull piece is replaced.

Middle Meningeal Artery (MMA) Embolization

MMA is newer and offers a minimally invasive approach. For now, it is mostly used for chronic subdural hematomas. It involves directly blocking the artery that feeds the bleeding membranes.

Benefits:

  • Lower recurrence rates
  • Can be combined with burr hole drainage
  • Often performed by neurointerventional specialists

Subdural Hematoma FAQs

Can a subdural hematoma heal without surgery?

Some small subdural hematomas can resolve naturally over weeks to months. These cases still require monitoring by a specialist. Additionally, intervention may be indicated if your condition worsens.

Recovery timelines will depend on the treatment performed. For example, burr hole recovery typically takes 2–6 weeks. More extensive procedures like craniotomy can take several months for full recovery. Dr. Sarkiss will provide a clear timeline based on your condition details and procedure outline.

Symptoms that may indicate progression include increasing:

  • Headaches
  • Confusion
  • Drowsiness
  • Weakness on one side of the body
  • Difficulty speaking
  • Seizures

Older adults are indeed more susceptible to subdural hematomas. With age, several physiological changes occur, increasing risk. Namely, brain shrinkage can stretch bridging veins, which then can rupture with even minor head trauma. Additionally, patients taking blood-thinning medications can have an increased risk of subdural hematoma.

Recurrence is possible. While the procedure treats the condition, it does not address the underlying risk factors that can lead to the bleeding. Still, recurrence rates are low, with only 10–20% of patients experiencing them. Among this group, it is mostly patients who had chronic subdural hematomas.

Certain factors can help reduce the risk of recurrence, including:

  • Working with a board-certified brain surgeon
  • Proper surgical drainage
  • Treatment via middle meningeal artery embolization
  • Careful adherence to post-procedure care
  • Taking steps to reduce risk factors (e.g., smoking cessation)

Patients may need rehabilitation, but it is not always required. The need for rehabilitation steps largely depends on the severity of the injury. Such a program can include:

  • Physical therapy
  • Occupational therapy
  • Cognitive rehabilitation
  • Balance training