Korean J Neurotrauma.  2018 Oct;14(2):134-137. 10.13004/kjnt.2018.14.2.134.

Craniotomy and Membranectomy for Treatment of Organized Chronic Subdural Hematoma

• Baek HG
• Park SH

• KMID: 2424326
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.134

Abstract

We report the case of a patient with organized chronic subdural hematoma (OCSH) that was treated with craniotomy. A 72-year-old man was admitted with a complaint of a drowsy mental status after a generalized tonic-clonic seizure. A brain computed tomography scan acquired at a local hospital revealed a large chronic subdural hematoma (CSDH) in the left frontoparietal lobe. The patient had not experienced head trauma and had been taking clopidogrel due to angina. A neurosurgeon at the local hospital performed single burr hole trephination in the left frontal bone and drained some of the hematoma. Brain magnetic resonance imaging performed upon transfer to our hospital showed a large OCSH with a midline shift to the right side, revealing a low, heterogeneous signal on T2-weighted images (WI) and an isodense signal on T1-WI. We performed craniotomy and membranectomy to achieve adequate decompression and expansion of the brain. Following this, the patient recovered completely. Our findings support that neurosurgeons should consider the possibility of organization of a CSDH when selecting a diagnosis and treatment plan.

Keyword

Chronic subdural hematoma; Craniotomy; Organized

MeSH Terms

Aged
Brain
Craniocerebral Trauma
Craniotomy*
Decompression
Diagnosis
Frontal Bone
Hematoma
Hematoma, Subdural, Chronic*
Humans
Magnetic Resonance Imaging
Neurosurgeons
Seizures
Trephining

Figure

• 

  FIGURE 1 Brain computed tomography (CT) scan (A) showed chronic subdural hematoma containing many high density areas in the hematoma and the membrane in the left frontoparietal lobe with a midline shift. After burr hole surgery, brain CT axial (B) and coronal (C) scans demonstrated insufficient drainage of the hematoma through a single burr hole.

• 

  FIGURE 2 Brain magnetic resonance imaging showed a large amount of chronic subdural hematoma with a low, heterogeneous signal on T2-weighted images (WI) (A), an isodense signal on T1-WI (B), and a low, homogeneous signal on diffusion-WI (C). There was no strong enhancement and the membrane surrounding the hematoma was enhanced in a line (D).

• 

  FIGURE 3 Operative findings showed organized chronic subdural hematoma with a thick membrane (A). Note the normal brain cortex after membranectomy (B).

• 

  FIGURE 4 Brain computed tomography showed no recurrence of chronic subdural hematoma with subdural fluid collection.

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