A subdural hematoma (SDH) is a collection of blood trapped between the brain’s protective layers — the dura mater and arachnoid mater. It typically results from head injuries that tear veins, causing blood to pool and put pressure on the brain.
While surgical drainage is often advised for larger or symptomatic hematomas, not every patient undergoes surgery. Dr. Gurneet Sawhney, an eminent neurosurgeon in Mumbai, shares:
“Deciding against surgery for a subdural hematoma can happen for various reasons, such as patient frailty, minimal symptoms, or very small bleeds. In these situations, careful monitoring is critical to prevent worsening.”
In this blog, let’s explore why surgery might not be performed, what the prognosis is like, and how conservative management can help support quality of life.
Why Surgery May Not Be Performed
There are circumstances where surgery is not the preferred option:
Small or Stable Hematomas: When the bleed is minor and not causing significant pressure, doctors may recommend watchful waiting.
Patient’s Health Condition: Frail elderly patients or those with multiple medical conditions may not tolerate anesthesia or surgery well.
Patient Choice: Some individuals, after understanding the risks and benefits, may decline surgery.
Is your loved one being managed conservatively for a subdural hematoma? It’s vital to work closely with an experienced neurosurgeon for ongoing guidance.
Expected Outcome and Life Expectancy Without Surgery
Life expectancy can vary greatly and depends on several factors:
Without surgery, some subdural hematomas can resolve spontaneously through the body’s natural reabsorption process. However, larger or expanding hematomas can progressively increase pressure inside the skull, leading to permanent neurological damage, coma, or even death if untreated.
Dr. Sawhney cautions:
“The natural course of an untreated subdural hematoma can be unpredictable. Regular monitoring with imaging and neurological assessments is crucial.”
Risks and Complications
Choosing conservative management does carry risks:
Hematoma enlargement over time, increasing brain pressure.
Sudden onset of severe headaches, confusion, or weakness.
Seizures due to brain irritation.
Potential for life-threatening brain herniation in severe cases.
Conservative Management and Monitoring
When surgery is not performed, close observation becomes the backbone of care:
“Conservative treatment doesn’t mean passive care. It requires active follow-ups and immediate intervention if the hematoma grows.”
Quality of Life Considerations
Quality of life after an untreated subdural hematoma depends on how well symptoms are controlled:
Family support, rehabilitation therapy, and a strong care plan can help improve outcomes.
Conclusion
In summary, life expectancy after a subdural hematoma without surgery depends on the hematoma’s size, the patient’s health, and vigilant monitoring. While some patients may live many years with minimal impact, others may face serious complications without timely intervention.
Dr. Sawhney reassures families:
“Every patient’s situation is unique. An individualized plan, regular check-ups, and being alert to changes make all the difference in outcomes.”
Frequently Asked Questions
Can a subdural hematoma go away on its own?
Small, stable hematomas can be reabsorbed naturally, but ongoing scans are needed to ensure they don’t grow.
How often should imaging be done?
Your neurosurgeon will decide the frequency, often starting with scans every few weeks to months.
What are warning signs that require urgent care?
Sudden severe headaches, confusion, weakness on one side, or new seizures need emergency medical help.
Can lifestyle changes help?
Yes — managing blood pressure, avoiding falls, and carefully using any blood-thinning medicines are key.
Is home care enough for conservative management?
Home care must be combined with medical supervision and immediate hospital access if symptoms worsen.
Disclaimer: The information shared in this content is for educational purposes only and not for promotional use.