title: Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy.
abstract: OBJECTIVE
  Chronic subdural hematoma (cSDH) is common condition in neurosurgical field. It is difficult to select the treatment modality between the surgical method and the conservative method when patients have no or mild symptoms. The purpose of this study is to provide a suggestion that the patients could be cured with conservative treatment modality.
  
  
  METHODS
  We enrolled 16 patients who had received conservative treatment for cSDH without special medications which could affect hematoma resolution such as mannitol, steroids, tranexamic acid and angiotensin converting enzyme inhibitors. The patients were classified according to the Markwalder's Grading Scale.
  
  
  RESULTS
  Among these 16 patients, 13 (81.3%) patients showed spontaneously resolved cSDH and 3 (18.7%) patients received surgery due to symptom aggravation and growing hematoma. They were categorized into two groups based on whether they were cured with conservative treatment or not. The first group was the spontaneous resolution group. The second group was the progression-surgery group. The mean hematoma volume in the spontaneous resolution group was 43.1 mL. The mean degree of midline shift in the spontaneous resolution group was 5.3 mm. The mean hematoma volume in the progression-surgery group was 62.0 mL. The mean degree of midline shift in the second group was 6 mm.
  
  
  CONCLUSIONS
  We suggest that the treatment modality should be determined according to the patient's symptoms and clinical condition and close observation could be performed in patients who do not have any symptoms or in patients who have mild to moderate headache without neurological deterioration.
authors.affiliation: Department of Neurological Surgery, College of Medicine, Dankook University, Cheonan, Korea.
authors.forename: Hyung Chan
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, College of Medicine, Dankook University, Cheonan, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Ko
authors.affiliation: Department of Radiology, College of Medicine, Dankook University, Cheonan, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Yoo
authors.affiliation: Department of Neurological Surgery, College of Medicine, Dankook University, Cheonan, Korea.
authors.forename: Sang-Koo
authors.initials: SK
authors.lastname: Lee
keywords: Chronic subdural hematoma; Close observation; Treatment