Fibrin glue injection into the hematoma cavity for refractory chronic subdural hematoma: A case report

Abstract

Background:Repeat burr hole irrigation and drainage has been effective in most cases of recurrent chronic subdural hematoma (CSDH), however, refractory cases require further procedures or other interventions.Case Description:An 85-year-old male presented with left CSDH, which recurred five times. The hematoma was irrigated and drained through a left frontal burr hole during the first to third surgery and through a left parietal burr hole during the fourth and fifth surgery. The hematoma had no septation and was well-evacuated during each surgery. Antiplatelet therapy for preventing ischemic heart disease was stopped after the second surgery, the hematoma cavity was irrigated with artificial cerebrospinal fluid at the third surgery, and the direction of the drainage tube was changed to reduce the postoperative subdural air collection at the fourth surgery. However, none of these interventions was effective. He was successfully treated by fibrin glue injection into the hematoma cavity after the fifth surgery.Conclusion:This procedure may be effective for refractory CSDH in elderly patients.

Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan

“…In hospital mortality rate of 1.4% has been reported,15 with much higher rates after one year 3. In this study, 23.3% were agonized by recurrence, with no significant difference among various age groups; these results were comparable to 20-22% recurrence rates in other literature, where elderly suffered more 2,15…”

“…Various surgical manoeuvres are available, nevertheless, optimal technique remains controversial 10-12,14,16-18. Less invasive procedures like twist-drill craniostomy (TDC) and burr-hole drainage(BHD) often gain priority;1,2,13,16-18 former being more safe and effective method for maximal thickness areas, or for bedside drainage of patients at high risk for surgery 15,16,19…”

“…Chronic subdural hematoma (CSDH) is one of the most frequently encountered malady in neurosurgical clinics 1. It is generally considered as benign and easily treatable problem with an increasing incidence with age 2-4. If not timely diagnosed or treated, it carries significant morbidity or mortality and vice versa; and is also a treatable cause of stroke and dementia in peculiar groups.…”

“…A multitude of surgical drainage procedures are available but clear-cut guidelines are jeopardized and scanty. Single or double burr hole drainage is the first-line therapy, being most effective and frequently utilized, with minimal co-morbidities, complications and recurrence 1,2. Nonsurgical management is reserved for asymptomatic or patients at high risk for operation 1.…”

How to Treat Chronic Subdural Hematoma? Past and Now

“…Since trephination with closed system drainage is easy, safe and effective, lumbar or ventricular injection is seldom used. Refractory CSDHs may require complete obliteration of the subdural hematoma cavity by reducing the dura or fibrin glue injection [ 61 , 92 ]. When there is a macrocephaly from expanding CSDH, reduction cranioplasty may become the last choice [ 55 , 81 ].…”