Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma

Abstract

Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

Burr hole drainage without irrigation for chronic subdural hematoma

“…of cerebrospinal fluid might cause remote intracranial hemorrhage after burr hole surgery. [7,16] In our institution, we insert a drainage tube into the hematoma cavity through a small dura incision and do not perform intraoperative irrigation to avoid a rapid decrease in the intracranial pressure. e drainage would be gradually initiated after the surgery.…”

Hyperperfusion and intracranial hemorrhage after burr hole surgery of chronic subdural hematoma

“…The clinical and radiological summaries of all the patients are shown in [ Table 1 ]. [ 3 - 6 , 8 , 9 , 11 - 14 , 19 , 20 ] Of the total 17 patients, 16 (94%) had favorable outcomes, including good recovery (88%) and moderate disability (6%). Twelve cases (70.5%) presented with intracerebral hemorrhage (ICH), and only 2 presented IVH.…”

“…It was previously reported that rapid or excessive postoperative drainage should be avoided. [6] To reduce the complication, slow and gradual decompressive drainage of CSDH must be performed carefully.…”

A closed system irrigation & drainage technique for surgical evacuation of chronic subdural haematomas

“…There is evidence in the literature suggest that sudden evacuation of chronic subdural hematoma may lead to growth or development of remote (contralateral) subdural, epidural or intra-cerebral haematomas 13 – 17 . The possible mechanisms behind this phenomenon include the rapid shift of the cerebral hemisphere following hematoma evacuation, over drainage of the subdural space, and cerebral hyperperfusion syndrome, although the actual pathophysiology behind this process remains unclear 16 – 20 .…”