Unilateral drainage of bilateral chronic subdural hematoma

Bilateral chronic subdural hematoma (bCSDH) is a condition frequently encountered in neurosurgical practice, and it is usually the result of head trauma. Despite its frequency, no consensus currently exists regarding its optimal treatment. While the use of corticosteroids in the treatment of chronic subdural hematoma is not currently accepted by the neurosurgical community, there is enough evidence in the literature that supports its use. In bCSDH the unilateral burr hole evacuation of the larger of the subdural collections followed by a course of corticosteroids seems to be an effective and safer course of action in the management of bilateral chronic subdural hematoma.

Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma

Background: Bilateral chronic subdural hematoma (bCSDH) is a frequent condition commonly linked to the need for retreatment; however, the reason for this high retreatment rate remains unclear. The middle meningeal artery (MMA) was found to have a relationship with the occurrence and development of chronic subdural hematomas. This study examines a possible method to reduce bCSDH recurrence using bilateral MMA embolization combined with bilateral burr-hole drainage.Materials and Methods: Ten patients with bCSDH who underwent bilateral MMA embolization combined with bilateral burr-hole drainage at our hospital between June 2018 and May 2020, were retrospectively analyzed. Patients' clinical information, prognoses, imaging results, as well as surgical results were documented and analyzed.Results: Ten patients were diagnosed with bCSDH with no comorbid brain diseases. They underwent bilateral MMA embolization combined with bilateral burr-hole drainage. We embolized the MMA immediately before burr hole drainage successfully and employed angiography to validate these results. All the patients attained relief of symptoms without adverse events, and no re-expansion or relapse was reported in the follow-up computed tomography.Conclusion: Bilateral MMA embolization combined with bilateral burr-hole drainage is an available treatment for patients with bCSDH and may have the potential for preventing recurrence.

Acute on Chronic Bilateral Subdural Hematoma in a Woman with a Remote History of Previous Subdural Hematoma Managed by Trephination: A Case Report

Bilateral chronic subdural hematoma are not that common. It may be recurrent and rarely superimposed by acute bleed leading to rapid progression and poor clinical outcomes. We report the case of a seventy six years old lady with a history of traumatic subdural hematoma evacuated by trephination twenty years back, presenting at our hospital with a history of persistent headache and acute onset of several episodes of vomiting. A non-contrast head CT revealed bilateral chronic subdural hematoma with acute on chronic bleed on one side. Trephination was done initially unilaterally, but the symptoms persisted and bilateral trephination was performed. The patient developed bilateral pneumocephalus and chest infection post-surgery. Bilateral, recurrent subdural hematoma with acute superimposition of bleed is a rare entity that presents with signs of increased intracranial pressure as opposed to unilateral SDH. A single burr hole trephination can be an effective intervention in these cases.

Multiple contralateral recurrence of bilateral chronic subdural hematoma: case report and literature review

We report a case of bilateral chronic subdural hematoma (CSDH) operated with a single burr-hole on the more symptomatic side (left) followed by a symptomatic expansion of the contralateral (right) hematoma 7 days after the surgery treated again with a burr-hole on the other side. A week later the patient presented again a bilateral CSDH that was re-operated on both side with a good outcome at 6 months follow-up. Relevant literature was reviewed, and we believe that the multiple recurrence of these hematomas in the opposite hemisphere resulted from the rapid drainage of the hematoma, which caused the rupture of weak bridging veins during drainage. Slow decompression is recommended to avoid rapid intracranial changes during drainage of a subdural hematoma.

Bilateral Chronic Subdural Hematoma in the Posterior Fossa Treated with a Burr Hole Irrigation: A Case Report and Review of the Literature

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare. The surgical strategy is still controversial. We report a case of bilateral CSH in the posterior fossa successfully treated with a single-burr hole surgery. A 74-year-old man under anticoagulation and antiplatelet therapy developed headache and nausea during observation for an asymptomatic supratentorial CSH. Radiological examinations revealed appearance of bilateral CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient’s consciousness, an urgent treatment was required. A burr hole was made near the transverse-sigmoid junction on the left side to access the hematoma. No ventricular drainage was placed as his consciousness improved during the decompression of the hematoma. Postoperative computed tomography showed that bilateral CSH and hydrocephalus had been successfully treated. In bilateral CSH in the posterior fossa, there may be a connection between each side. CSH in the posterior fossa, when urgent, can be treated under local anesthesia with a unilateral burr hole irrigation.