Bilateral Chronic Subdural Hematomas of the Posterior Fossae

Abstract

An 86-year-old female presented with rare bilateral chronic subdural hematomas (CSHs) of the posterior fossae which were successfully treated by surgical intervention. She had experienced mild head trauma one month before admission. She was transferred to our hospital because of consciousness disturbance and tetraparesis. Magnetic resonance (MR) imaging showed simultaneous occurrence of supratentorial and infratentorial CSHs. We tried to evacuate the CSHs of the bilateral posterior fossae because brainstem compression was markedly severe. Through bilateral burr-hole trepanations, chocolate-colored fluid, not containing clotted components, gushed out under great pressure. Postoperative course was uneventful. MR imaging revealed that the CSHs of the posterior fossae had completely disappeared and brainstem compression had also improved. The patient's neurological deficits were immediately improved after the operation. The patient was discharged one month after the operation for further rehabilitation. Trepanation and evacuation of the hematoma through the posterior fossa might be one of the therapeutic options for posterior fossa CSH, which is similar to supratentorial CSH. However, we considered that the emergency of this rare entity and the method of anesthesia were quite different from supratentorial CSH.

Bilateral posterior fossa chronic subdural hematoma treated with craniectomy: Case report and review of the literature

“…[ 4 ] As shown in Table 1 , the number of patients with a preoperative diagnosis of pCSH has increased in the CT era ( n = 13, including our patients). [ 2 5 7 8 10 11 12 13 14 ]…”

“…[ 2 5 7 12 13 ] Reported treatments are conservative, craniectomy, and burr hole craniostomy. [ 1 2 5 7 8 10 11 12 13 14 ] Short-term closed drainage with the drainage tube placed in the hematoma has been used in surgically treated patients. As shown in Table 1 , the clinical treatment outcome was satisfactory in the previously-reported and our patient ( n = 13); based on the GOS, 11 patients enjoyed a good outcome and 2 experienced mild disturbances.…”

“…As shown in Table 1 , the clinical treatment outcome was satisfactory in the previously-reported and our patient ( n = 13); based on the GOS, 11 patients enjoyed a good outcome and 2 experienced mild disturbances. [ 10 12 ]…”

“…Therefore, early surgical intervention has been recommended as the safer choice. [ 1 2 5 10 13 ] The use of burr hole craniostomy has increased and yielded good results,[ 10 12 13 ] and some have suggested that the appropriate treatment is the same in patients with pCSH and sCSH. [ 2 5 10 13 ]…”

“…[ 1 5 7 12 13 ] No standard treatments have been established. [ 10 14 ] We encountered unexpected, but easily stopped intraoperative bleeding in a patient with pCSH who underwent craniectomy. We discussed the treatment of pCSH based on our experience and review the literature.…”