Korean J Neurotrauma.  2017 Oct;13(2):144-148. 10.13004/kjnt.2017.13.2.144.

Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma

• Kim CH
• Song GS
• Kim YH
• Kim YS
• Sung SK
• Son DW
• Lee SW

• KMID: 2394550
• DOI: http://doi.org/10.13004/kjnt.2017.13.2.144

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.

Keyword

Burr-hole trephination; Catheter drainage; Chronic subdural hematoma; CSF overdrainage; Remote hemorrhage; Symptomatic subdural hygroma

MeSH Terms

Catheters
Cerebral Hemorrhage
Cerebrospinal Fluid
Craniotomy
Drainage*
Hematoma, Subdural, Acute
Hematoma, Subdural, Chronic*
Hemorrhage*
Humans
Recurrence
Subarachnoid Hemorrhage
Subdural Effusion
Subdural Space
Trephining

Figure

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  FIGURE 1 Preoperative brain magnetic resonance imaging images revealing an arachnoid cyst in the left middle cranial fossa and subdural hygroma in the left hemisphere.

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  FIGURE 2 (A, B) Postoperative imaging immediately after the procedure does not reveal any specific findings, however, (C, D) newly developed subarachnoid hemorrhage and intracerebral hemorrhage are observed on computed tomography imaging the day after surgery.

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  FIGURE 3 Magnetic resonance angiography does not reveal any abnormal vascular structures.

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  FIGURE 4 Brain computed tomography imaging showing bilateral chronic subdural hematoma with the loss of sulci markings. Additionally, the right temporal lobe is smaller than the left temporal lobe, suggesting the presence of a small arachnoid cyst on the right middle cranial fossa.

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  FIGURE 5 Brain computed tomography imaging 3 days after surgery. The sudden overdrainage of cerebrospinal fluid is associated with a newly developed hemorrhage in the subdural space and a small amount of intraventricular hemorrhage.

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