Zasan's Grading for Unilateral Chronic Subdural Hematomas: Comparison of Clinical Conditions on the Background of Radiological Findings

A correlation cannot be established between clinical findings and hematoma thickness in Chronic Subdural Hematoma cases. The effects of hematoma on intracranial structures can be evaluated as a grading criterion. This study aims to establish a grading system by establishing a correlation between the compression effects of hematoma and clinical conditions in Chronic Subdural Hematoma cases. The radiological and clinical findings of the cases diagnosed with Chronic Subdural Hematoma were recorded. Headache, dizziness, focal neurological deficit, and reduction in Glasgow Coma Scale scores were recorded as clinical criteria. Radiologically, a 4-grade grading system was prepared. Hematoma without compression effect, dural compression and sulcus effacement, parenchymal compression, and midline shift of more than 5 mm were used in the grading system, respectively. The clinical symptoms and signs within each grade were recorded. Computed Tomography examinations and clinical findings of 414 cases were recorded. It has been noted that as the grade increases, the clinical symptoms and signs increase along with the increase in hematoma thickness. However, it has been noted that an absolute correlation cannot always be established between hematoma thickness and clinical symptoms. The grading system is instructive in showing the effects of hematoma on intracranial structures rather than hematoma thickness in Chronic Subdural Hematoma cases. Complete drainage of hematoma is rare in surgically treated cases. Clinical improvement is associated with optimal intracranial dynamics rather than hematoma thickness. The grading system is instructive regarding clinical and radiological follow-up of the cases.