A case report and technical tip of chronic subdural hematoma treated by the placement of a subdural peritoneal shunt

Abstract

Background: Chronic subdural hematomas (CSDH) tend to occur most commonly in the elderly population, usually resulting from minor or insignificant head trauma. The pathophysiology behind CSDH is often directly associated with cerebral atrophy, and other causes of cerebral atrophy such as alcoholism or dementia. Other predisposing factors include diabetes, coagulopathy, use of anticoagulants (including aspirin), seizure disorders, and CSF shunts. Considerable evidence supporting the use of external drainage after evacuation of primary CSDH is readily available in the literature.

Case report: We report the case of a 72 year-old male with a history of recurrent left subdural hematoma presenting to the neurosurgical clinic with a two-day history of personality changes, difficulty speaking, urinary incontinence, and headaches. Burr hole evacuation was performed with the placement of a subdural peritoneal shunt. At the one-month follow-up appointment, the patient had complete resolution of symptoms and CT scan showed no new recurrence of the subdural hematoma.

Conclusions: Although several treatment options are available for the management of CSDH, recurrence of hematoma is a major and very common complication that may result in re-injury due to mass effect caused by chronic hematoma. However, placement of subdural peritoneal shunt for the treatment of CSDH can reduce the recurrence rate of CSDH and therefore, reduce the risk of brain re-injury.

Keywords: CSDH; Chronic subdural hematoma; Head trauma; Subdural peritoneal shunt.

Fig. 1

A. Brain CT scan pre-op. Image showing a large right subacute subdural hematoma causing subfalcine herniation, impending uncal herniation, right to left shift of 1.0 cm mass effect and ipsilateral ventricles. B. One-month status-post neurosurgical evacuation of right subdural hematoma. Burr hole is present at the parietal convexity. Subdural drainage catheter is seen, stable in position. Previously present right subdural air has resolved. No extra-axial fluid collections identified from the level of the foramen of Monro, to the convexity. No acute intracranial hemorrhage.