Spontaneous Bilateral Chronic Subdural Haematoma of the Posterior Fossa. Case Report and Review of the Literature

Abstract

The chronic subdural haematomas in this patient may have been due to rupture of bridging veins caused by a very mild trauma not noticed by the patient and possibly aggravated by the anticoagulation therapy. Infratentorial chronic subdural haematoma should at least be a part of the differential diagnosis in elderly patients with cerebellar and vestibular symptomatology even without a history of trauma.

Bilateral Chronic Subdural Hematomas of the Posterior Fossae

“…We considered that small craniectomy, including trepanation or twist drill craniostomy, is sufficient and effective to treat this rare disease, which is a less invasive method. Previous cases of bilateral CSHs of the posterior fossae, 16,18) which were similar to our case, were treated successfully with evacuation of hematoma by bilateral trepanation. Although the detailed operative procedures were not described, 16,18) we speculated the method used was very similar to the present procedure.…”

“…9,18) However, despite improvements in imaging techniques, CSH of the posterior fossa is extremely rare in the adult population. Only 3 of 535 intracranial subdural hematomas were located in the posterior fossa.…”

“…5) Only 10 cases have been reported since the introduction of CT (Table 1). 1,2,6,[11][12][13]16,18) These reports highlight the rarity, 1,12,13) the developmental mechanism, 6,18) or the difficulty of diagnosis. 2,11,16) In general, burr-hole surgery or twist-drill craniostomy over the skull convexity under local anesthesia and slight sedation is often performed for symptomatic supra- …”

“…1,2,4,6,[11][12][13]16,18) Burr-hole evacuation and irrigation with or without closed-system drainage has been widely accepted as the optimum method to treat supratentorial CSH, 3,8,14,15,17,19) but the optimal therapeutic strategy for CSH of the posterior fossa is still controversial. Here, we present a case of bilateral CSHs located in the posterior fossae which were successfully treated by posterior fossa trepanation and evacuation of the hematomas.…”

“…1,2,6,12,13,16,18) For example, some cases of unilateral CSH of the posterior fossa were treated with lateral suboccipital craniectomy. However, there are no detailed records of the operative procedure in these reports.…”