The Clinical Presentation, Treatment Modalities, and Outcomes Associated with Interhemispheric Subdural Hematomas

Abstract

Interhemispheric subdural hematoma (ISH) poses significant challenges in neurosurgical practice owing to its deep localization within the cerebral hemispheres. Despite widespread adoption of advanced neurosurgical technologies, adverse patient outcomes hinder progress in enhancing overall prognosis. This review seeks to evaluate the etiology, clinical manifestations, treatment modalities, and outcomes associated with ISHs, thereby informing clinical decision-making and improving patient care. Databases such as PubMed, Scopus, and Google Scholar were systematically searched from 1964 to 2024. The search was limited to studies involving human subjects and published in English. Keywords such as "interhemispheric subdural hematoma" and "parafalcine subdural hematoma" were used in various combinations to identify relevant articles. Our search identified 167 individuals (87 females and 80 males) ranging in age from 6 weeks to 93 years. Trauma emerged as the leading risk factor, accounting for 86.8% of cases. Nausea and vomiting were the most frequent symptoms (14.7%), followed by headache (11.8%). Most patients (22.8%) had a Glasgow Coma Scale score of 13 to 16, indicating moderate severity. Radiological analysis showed that subdural hematomas were almost evenly distributed between hemispheres, with 51% located in the right hemisphere and 49% in the left. Quantitative analysis revealed that 65.1% of patients were managed conservatively, particularly those with minimal neurological impairment, while 34% underwent surgery, including burr hole drainage and craniotomy. Of the surgical cases, 18.4% experienced complications. Our findings reveal that the outcome of ISH management depends on several factors, the most important being the etiology and size of the hematoma, the clinical presentation and comorbidities of the patient, and the interval between presentation and treatment.