J Korean Neurosurg Soc.  2015 May;57(5):379-385. 10.3340/jkns.2015.57.5.379.

Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas

• Rusconi A
• Sangiorgi
• Bifone L
• Balbi S

• KMID: 1881738
• DOI: http://doi.org/10.3340/jkns.2015.57.5.379

Abstract

Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.

Keyword

Chronic subdural hematoma; Subarachnoid hemorrhage; Remote cerebellar hemorrhage; Head trauma

MeSH Terms

Aged
Brain
Cerebrospinal Fluid
Craniocerebral Trauma
Craniotomy
Decompression
Drainage*
Hematoma, Subdural, Acute
Hematoma, Subdural, Chronic*
Hemorrhage
Humans
Hypertension
Intracranial Hypotension
Pneumocephalus
Recurrence
Subarachnoid Hemorrhage
Substance-Related Disorders

Figure

• 

  Fig. 1 Head CT showing a large right CSH with midline shift. CSH : chronic subdural hematoma.

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  Fig. 2 Post-operative head CT showing diffuse SAH in the basal cisterns (A) and over cerebral convexity (B). SAH : subarachnoid hemorrhage.

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  Fig. 3 CT scan showing a large right CSH with recent blood. CSH : chronic subdural hematoma.

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  Fig. 4 Right sylvian SAH (A) and contralateral occipital hematoma (B) on a post-operative head CT. SAH : subarachnoid hemorrhage.

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  Fig. 5 Pre-operative head CT showing a right CSH and a contralateral hemispheric hygroma. CSH : chronic subdural hematoma.

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  Fig. 6 Post-operative head CT showing a small left temporal hematoma and subdural blood along the tentorium (A) and a cerebellar hemorrhage (B).

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