Beyond the bone flap: integrating biomarkers, imaging, and emerging technologies in the surgical continuum of acute subdural hematoma (ASDH).
Authors
Affiliations (7)
Affiliations (7)
- Lady Hardinge Medical College, New Delhi, India.
- State University of Campinas (UNICAMP), Cidade Universitária "Zeferino Vaz", Campinas, São Paulo, Brazil.
- Texila American University Zambia, Lusaka, Zambia.
- Van Provincial Health Directorate, Turkish Ministry of Health, Hatuniye, İpekyolu, Van, Türkiye.
- Tbilisi State Medical University, Tbilisi, Georgia.
- ESIC Medical College and Hospital, New Industrial Township, Faridabad, India.
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Abstract
Acute subdural hematoma (ASDH) is a life-threatening neurosurgical emergency associated with high mortality and long-term functional disability. Despite advances in surgical techniques, outcomes remain variable, highlighting the need for a more integrated management approach. Traditional decision-making has focused primarily on choosing between craniotomy and decompressive craniectomy, without fully incorporating postoperative recovery and rehabilitation. A narrative synthesis of literature published between 2010 and 2025 was conducted using PubMed, Embase, and Scopus databases. Studies were identified using predefined keywords related to "acute subdural hematoma," "traumatic brain injury," "biomarkers," "neuroimaging," and "surgical management," and were selected based on relevance to ASDH-specific or severe traumatic brain injury literature, with prioritization of high-quality clinical and translational studies. Advances in biomarkers, imaging modalities, surgical strategies, and emerging technologies were analyzed with emphasis on building a continuous care model for ASDH. Findings indicate that integrating inflammatory, coagulation, and neurodegeneration biomarkers enhances early risk stratification and supports surgical decision-making. The role of cranioplasty is no longer merely reconstructive but therapeutic, aiding in the restoration of cerebral hemodynamics, brain metabolism, and cognitive recovery. Emerging technologies - including magnetic resonance-guided focused ultrasound, 3D-printed implants, and AI-based imaging analytics - expand opportunities for personalized treatment. In conclusion, ASDH should be understood as a surgical-therapeutic continuum extending beyond hematoma evacuation, where the integration of biological insights, technological advances, and equity principles can transform survival, functional outcomes, and quality of life across diverse global healthcare settings.