Das chronisch subdurale Hämatom

Das chronische Subduralhämatom (cSDH) ist eine langsam wachsende Flüssigkeitsansammlung zwischen Dura mater und Arachnoidea, meist nach Bagatelltrauma und oft bei älteren Menschen vorkommend. Symptome wie Kopfschmerzen, Verwirrtheit oder Lähmungen entwickeln sich schleichend und werden häufig spät erkannt. Die Therapie symptomatischer cSDH erfolgt meist neurochirurgisch, aber es zeichnen inzwischen sich neue – endovaskuläre – Behandlungsmethoden ab.

Kernaussagen

• Das chronisch subdurale Hämatom (cSDH) ist ein häufiges Krankheitsbild, dessen Inzidenz über die Zeit zunimmt und zunehmen wird.

• Klinisch ist die Symptomatik bunt und die Entwicklung manchmal schleichend.

• Es handelt sich um eine der seltenen Ursachen einer sog. „reversiblen demenziellen Entwicklung“.

• Die Behandlung des cSDH hängt von verschiedenen Faktoren (wie z.B. dem raumfordernden Effekt, dem neurologischen Zustand des Patienten etc.) ab.

• Bei asymptomatischen Patienten ohne wesentlichen raumfordernden Effekt kann ggf. konservativ (also beobachtend) vorgegangen werden.

• Die Operationsindikation beim cSDH wird in der Regel bei neurologischem Defizit oder aufgrund der Größe bzw. des raumfordernden Effekts des Befundes gestellt.

• Die häufigste Behandlung besteht dann in der chirurgischen Entlastung; es werden verschiedene Trepanationsmethoden eingesetzt.

• Die middle Meningeal Artery Embolization (A.-meningea-media-Embolisation, MMAE) kann in speziellen Fällen eine Alternative zur operativen Entlastung bzw. deren Ergänzung darstellen

Schlüsselwörter

Subduralhämatom - Altersmedizin - Neurochirurgie - Trepanation

Publication History

Article published online:
19 September 2025

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