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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 21-23

Unexpected complications encountered in surgical treatment of chronic subdural hematoma


Neurosurgery Department, Apollo First Med Hospitals, Chennai, Tamil Nadu, India

Date of Web Publication2-Apr-2018

Correspondence Address:
Kodeeswaran M
Apollo First Med Hospitals, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_31_17

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  Abstract 

Complications in chronic subdural hematoma (CSDH) surgery are usually rare. Sometimes, patients who underwent surgical treatment for CSDH develop complications such as pneumocephalus, recurrent hematoma, and subdural hygroma. We are reporting a case which had unexpected complications following CSDH surgical treatment.

Keywords: Craniectomy, membranectomy, subdural hygroma, tension pneumocephalus


How to cite this article:
Kodeeswaran, Rajendran, Muniyandi P, Mani AK, Karthiraj. Unexpected complications encountered in surgical treatment of chronic subdural hematoma. Apollo Med 2018;15:21-3

How to cite this URL:
Kodeeswaran, Rajendran, Muniyandi P, Mani AK, Karthiraj. Unexpected complications encountered in surgical treatment of chronic subdural hematoma. Apollo Med [serial online] 2018 [cited 2022 Jan 19];15:21-3. Available from: https://www.apollomedicine.org/text.asp?2018/15/1/21/229058


  Introduction Top


To emphasise the unexpected complications during the surgical treatment of chronic subdural hematoma.


  Case Report Top


A 44-year-old male had trivial head injury 2 months back. Computed tomography (CT) brain was normal at the time of head injury. After 45 days, he presented with a history of vomiting and altered sensorium for 1 week. Magnetic resonance imaging brain showed bilateral frontotemporoparietal chronic subdural hematoma (CSDH) [Figure 1]. The patient underwent bilateral burr hole evacuation of CSDH. First, 3 days in the postoperative period, the patient was apparently normal. Moreover, after 3 days, the patient developed altered sensorium, decreased conscious level, and decreased Glasgow Coma Scale of 7/15. The patient underwent repeat CT brain which was showing frontal sinus inner table defect through which air was accumulated inside the cranial cavity producing tension pneumocephalus [Figure 2]. The patient was shifted to Intensive Coronary Care Unit and he was given antimicrobial nasal O2 and antiedema measures. Slowly, he was improving in his conscious level and repeat CT brain showed resolution of pneumocephalus. After recovery, his conscious level was stable for 4–5 days, but again, he started deteriorating in his conscious level. CT brain repeated which was showing bilateral frontotemporoparietal chronic subdural hygroma with mass effect [Figure 3]. Due to his deteriorating conscious level, the patient was taken up for surgery. Bilateral mini frontoparietal craniectomy was done and membranectomy was done. Postoperative period, the patient started improving in his conscious level and had aspiration pneumonitis. He was electively intubated, tracheostomy was done, and respiratory care was given. Thereafter he showed rapid improvement and regained conscious level. He was weaned off from the ventilator and tracheostomy was closed. The patient was discharged with necessary postoperative follow-up medications.
Figure 1: Bilateral subdural hematoma

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Figure 2: Pneumocephalus

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Figure 3: Bilateral subdural hygroma

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  Discussion Top


CSDH [1] is accumulation of blood in between dura mater and brain which is usually treated by burr hole and evacuation of hematoma. Sometimes, it requires craniotomy and membranectomy.[2],[3],[4]

Pneumocephalus is accumulation of air inside the cranial cavity. Usually, it is treated by conservative management including nursing in flat position, nasal oxygen, and in vitro fertilization.[5],[6] Sometimes, the patients with pneumocephalus have altered sensorium and decreased conscious level because of pressure produced by the air over the cortical surface. Sometimes, if it is producing tension pneumocephalus [7],[8],[9] and CT scan showing Mount Fuji sign,[9] it requires surgical treatment. Surgical treatment available is syringe aspiration/burr hole craniotomy/craniotomy flap. Surgical procedure includes dural membrane incision, hematoma membrane incision, and saline irrigation.[2],[3],[4]

Another complication following CSDH surgery is recurrent bleeding, if the patient is on anticoagulants and the patient has coagulation abnormality, they may prone to recurrent subdural hematoma (SDH).[10],[11],[12]

Subdural hygroma is the condition where CSF accumulates in between dura and brain. Usually, this condition does not require surgical treatment. However, when the patient has symptoms such as altered sensorium, decreased conscious level, or neurological deficits, surgical intervention may be necessary.[13],[14]

Since the above-said patient had unexpected complications such as pneumocephalus and subdural hygroma, all these complications should be kept in mind while treating a patient of SDH.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005;107:223-9.  Back to cited text no. 1
    
2.
Gökmen M, Sucu HK, Ergin A, Gökmen A, Bezircio Lu H. Randomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas. Zentralbl Neurochir 2008;69:129-33.  Back to cited text no. 2
    
3.
White M, Mathieson CS, Campbell E, Lindsay KW, Murray L. Treatment of chronic subdural haematomas – A retrospective comparison of minicraniectomy versus burrhole drainage. Br J Neurosurg 2010;24:257-60.  Back to cited text no. 3
    
4.
Rocchi G, Caroli E, Salvati M, Delfini R. Membranectomy in organized chronic subdural hematomas: Indications and technical notes. Surg Neurol 2007;67:374-80.  Back to cited text no. 4
    
5.
Aoki N. A new therapeutic method for chronic subdural hematoma in adults: Replacement of the hematoma with oxygen via percutaneous subdural tapping. Surg Neurol 1992;38:253-6.  Back to cited text no. 5
    
6.
Gore PA, Maan H, Chang S, Pitt AM, Spetzler RF, Nakaji P, et al. Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus. J Neurosurg 2008;108:926-9.  Back to cited text no. 6
    
7.
Kawakami Y, Tamiya T, Shimamura Y, Yokoyama Y, Chihara T. Tension pneumocephalus following surgical evacuation of chronic subdural hematoma. No Shinkei Geka 1985;13:833-7.  Back to cited text no. 7
    
8.
Lavano A, Benvenuti D, Volpentesta G, Donato G, Marotta R, Zappia M, et al. Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma: Report of seven cases. Clin Neurol Neurosurg 1990;92:35-41.  Back to cited text no. 8
    
9.
Yamashita S, Tsuchimochi W, Yonekawa T, Kyoraku I, Shiomi K, Nakazato M, et al. The Mount Fuji sign on MRI. Intern Med 2009;48:1567-8.  Back to cited text no. 9
    
10.
Carlsen JG, Cortnum S. Recurrence of CSDH with and without postoperative drainage. Br J Neurosurg 2011;25:383-98.  Back to cited text no. 10
    
11.
Katano H, Kamiya K, Mase M, Tanikawa M, Yamada K. Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence. J Neurosurg 2006;104:79-84.  Back to cited text no. 11
    
12.
Rughani AI, Holmes CE, Penar PL. A novel association between a chronic subdural hematoma and a fibrinolytic pathway defect: Case report. Neurosurgery 2009;64:E1192.  Back to cited text no. 12
    
13.
Lee KS. The pathogenesis and clinical significance of traumatic subdural hygroma. Brain Inj 1998;12:595-603.  Back to cited text no. 13
    
14.
McCluney KW, Yeakley JW, Fenstermacher MJ, Baird SH, Bonmati CM. Subdural hygroma versus atrophy on MR brain scans: “The cortical vein sign”. AJNR Am J Neuroradiol 1992;13:1335-9.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Introduction
Case Report
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Case Report
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