New concept of surgical treatment of chronic subdural hematomas
https://doi.org/10.56618/2071-2693_2026_18_2_24
EDN: NSRCJC
Abstract
INTRODUCTION. Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions occurring in elderly patients. This article presents the clinical presentation, diagnostic results, and surgical treatment of patients with chronic subdural hematomas.
AIM. To study the clinical features of CSDH, analyze factors influencing the occurrence of postoperative complications, and evaluate treatment results depending on the surgical method used.
MATERIALS AND METHODS. A study was conducted between November 2021 and December 2025, including 117 patients with CSDH. Two groups of patients were formed. The first group consisted of 53 patients who underwent CSDH removal using various surgical techniques without the use of pathogenetic therapy. The second group included 64 patients who underwent endoscopically guided surgery in combination with specialized conservative therapy. All patients were assessed using accepted clinical and instrumental examination methods.
RESULTS. In this category of patients with chronic subdural hematoma, general cerebral symptoms were the predominant symptom, with pyramidal hemi-syndrome being the focal lesion. Diagnosis was based on native CT scanning using the Nakaguchi classification to guide surgical approach and prognosis. A predictive model for postoperative complications (binary logistic regression) was developed, enabling preoperative risk stratification of recurrence and postoperative complications in patients with CSDH, taking into account the combined influence of various factors. A new minimally invasive endoscopic technique, combined with conservative therapy, was pathophysiologically substantiated and clinically validated. It resulted in cavity debridement, capsule regression, and a reduction in recurrence. It was found that the volume of the cystic fibrosis decreased by 6.1 times in the second group and by 1.5 times in the first group. In the second group, a statistically significantly higher rate of good recovery was recorded—93.8 versus 56.6 % in the first group (Pearson’s ξ2 = 0.0001). Complications were found to be significantly more common in the first group than in the second group (Pearson’s ξ2 = 0.0001) 92.5 and 7.8 %, respectively. Postoperative mortality after surgical treatment was 15.0 % in patients in group 1 and 2.9 % in group 2.
CONCLUSION. The comparison of the results of clinical material demonstrated the possibility of successful treatment of CSDH using the method of conservative therapy and its combination with surgical methods.
Keywords
chronic subdural hematoma,
clinical presentation,
computed tomography,
Nakaguchi classification,
endoscopically controlled surgical treatment,
conservative treatment,
risk factors for recurrence
Supporting agencies: The study was performed without external funding
About the Authors
Yu. O. Ryabchikova
Vitebsk Regional Clinical Hospital
Belarus
Belarus
Yulia O. Ryabchikova, Neurosurgeon
210037; 37 Voinov-Internationalistov street; Vitebsk
Yu. G. Shanko
5th City Clinical Hospital
Belarus
Belarus
Yuri G. Shanko, Dr. of Sci. (Med.), Full Professor, Corresponding Member of the National Academy of Sciences of Belarus, Head at the Department
Neurosurgical Department
220026; 9 Filatova street; Minsk
L. P. Parkhach
Republican Scientific and Practical Center for Neurology and Neurosurgery
Belarus
Belarus
Lyudmila P. Parkhach, Neurosurgeon
Neurosurgical Department No. 1
220114; 24 F. Skoriny street; Minsk
N. E. Ivanova
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Natalya E. Ivanova, Dr. of Sci. (Med.), Full Professor, Distinguished Doctor
of the Russian Federation, Corresponding Member of the Russian Academy of Medical and Technical Sciences, Academician of the Academy of Medical and Technical Sciences, Full Member of the Petrovskaya Academy of Sciences and Arts, Member of the Board of the Association of Neurosurgeons of Russia, Member of the Board of the Babchin Association of Neurosurgeons, Member of the Geographical Society of Russia, Doctor of Functional and Ultrasound Diagnostics, Head at the Department, Professor at the Department
Scientific Department; Institute of Medical Education; Department of Neurology and Psychiatry
191025; 12 Mayakovskogo street; St. Petersburg
K. A. Samochernykh
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Konstantin A. Samochernykh, Dr. of Sci. (Med.), Professor of the Russian Academy of Sciences, Neurosurgeon of the Highest Category, Director
Department of Neurosurgery for Children No. 7
191025; 12 Mayakovskogo street; St. Petersburg
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Review
For citations:
Ryabchikova Yu.O., Shanko Yu.G., Parkhach L.P., Ivanova N.E., Samochernykh K.A. New concept of surgical treatment of chronic subdural hematomas. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2026;18(2):24-41. (In Russ.) https://doi.org/10.56618/2071-2693_2026_18_2_24. EDN: NSRCJC
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