Chronic Subdural Hematoma Treatment With Intra-Arterial Bevacizumab Injection

Eligibility Criteria

• * Adult patients (≥18 years)
• * Radiographic evidence of chronic subdural hematoma, including
• 1. Persistence of subdural blood more than 10 days after index traumatic injury or event
• 2. Presence of mixed density blood
• 3. Presence of subdural membranes
• * Can obtain informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization.
• * Pregnant, breastfeeding, or unwilling to practice contraception during participation in the study.
• * Patients with concomitant intracranial pathology other than subdural hematoma (e.g., intracranial malignancy).
• * Patients with known hypersensitivity to bevacizumab.
• * Patients with radiographic evidence of mass effect.
• * Patients have focal neurological deficits attributed to subdural hematoma.
• * Patient had craniotomy or burr hole operative procedures performed in preceding two weeks prior to onset of subdural hematoma.
• * Secondary causes apart from trauma for the chronic subdural hematoma, such as underlying vascular abnormality or tumor.
• * Emergent surgical evacuation is required for the patient.
• * Non-convexity chronic subdural hematoma, as the middle meningeal artery will not supply this area.
• * Coagulation abnormalities, including platelet count \<100,000 and/or international normalized ratio of \<1.5 despite attempts for correction.
• * Patients with known contraindications for angiography. Patients with contrast allergy will be premedicated with diphenhydramine and steroids.
• * Patient has known active systemic infection or sepsis.
• * Patient has contradiction to anesthetic agents used for conscious sedation/monitored anesthesia care (MAC).
• * Patient has life expectancy of less than six months due to comorbid terminal conditions.
• * Patient has a premorbid modified Rankin score (mRS) of 5 or greater.
• * Concurrent participation in another research protocol for investigation of an experimental therapy.