In the context of acute subdural hematoma, which surgical option is used to remove blood and control bleeding?

• A. Burr holes
• B. Craniectomy
• C. Craniotomy
• D. Endovascular clipping

Answer: (C)

The main concept is that evacuating an acute subdural hematoma with active bleeding requires direct surgical access to remove the clot and stop the bleeding. A craniotomy provides that access: a portion of the skull is removed to open the dura, the hematoma is evacuated, and bleeding vessels are coagulated to achieve hemostasis, then the bone flap is replaced. While burr holes can relieve pressure temporarily, they do not allow complete removal of a sizable acute clot. Craniectomy is used when there’s significant brain swelling and the skull bone isn’t replaced immediately. Endovascular clipping is for treating vascular lesions like aneurysms, not evacuating a subdural hematoma. Therefore, the procedure used to remove blood and control bleeding in acute subdural hematoma is craniotomy.