Although every time we talk about skull surgery we get nervous, the truth is that it is a low-risk intervention that is frequently performed by doctors who specialize in neurosurgery, as is my case.
Let’s understand it more easily. A chronic subdural hematoma is a collection of blood or its debris under the bony layer of the skull, between the membranes of the meninges that surround the brain. For its diagnosis, a CT scan is enough where an image in the shape of a crescent is appreciated, between the brain tissue and the bone.
Now, what causes a subdural hematoma?
It is usually the result of a severe or minor head injury, caused by:
- A strong blow to the head.
- Anticoagulant medications.
- Long-term alcohol consumption.
- Medical conditions that cause your blood to not clot properly.
- Repetitive head trauma from continuous falls.
And sadly, in infants and young children, a subdural hematoma can occur after child abuse and commonly appears as part of the abused child syndrome, from the blows it receives from adults.
Given this, how is the surgery to evacuate that accumulation of blood?
The method focuses on making one or two incisions in the scalp and a perforation of between 5 and 8 millimeters in diameter in the skull with a trephine, to drain the blood and relieve pressure on the brain.
An elastic drainage cannula is placed that allows the instillation of serum and then aspiration of serum and the blood or its debris accumulated in the hematoma. Of course, if the hematoma is very large, a larger portion of the bone is usually removed to be able to remove it.
Later, when it is verified that the hematoma has come out completely and the brain has already expanded, occupying the place that previously had the accumulation of blood, the wound is sutured.
But what if the hematoma was not completely removed?
In this situation, it will be necessary to leave a cannula in place to drain the remaining fluids for 24 or 48 hours, and then close the hole. Always in hospital and under specialist observation.
Now, what risks does this intervention involve?
Indeed, it is necessary to take measures to reduce the risk of infection or postoperative bleeding and prevent air from remaining in the cranial cavity.
In addition, what is commonly recommended is between five and seven days of hospitalization; and the recovery time can contemplate up to 3 months. It is precisely because of the sensitivity of the intervention that you cannot put your health in the hands of just anyone.
I am a surgeon from the National Autonomous University of Mexico (UNAM), and I specialized in neurosurgery at the “Manuel Velasco Suárez” National Institute of Neurology and Neurosurgery.
In addition, I did a subspecialty in Skull Base Surgery at the National Medical Center “20 de Noviembre” of the Institute of Social Security and Services for Workers of the State of Mexico (ISSSTE).
In Costa Rica, I have worked as a Specialist Assistant Physician in Neurosurgery, at the San Juan de Dios Hospital, of the Costa Rican Social Security Fund, and I have a lot of experience in this type of medical intervention. Contact me, I will gladly clarify your doubts and we will look for the most comprehensive and effective solution for your medical situation.
