Neuroendoscope-Assisted Removal of an Organized Chronic Subdural Hematoma in a Patient on Bevacizumab Therapy-Case Report-

Abstract

A 78-year-old Japanese man with a history of colon cancer was referred to our department of neurosurgery for the management of asymptomatic left chronic subdural hematoma (CSDH). He was receiving bevacizumab therapy for colon cancer, and the size of the CSDH increased or decreased depending on bevacizumab administration. Simple drainage was performed because of the risk of a critical increase in the size of CSDH during bevacizumab therapy, but since the CSDH was organized and firm, the drainage was insufficient. Therefore, neuroendoscope-assisted craniotomy was performed, and the organized CSDH was almost completely removed. The present case indicates the possible involvement of bevacizumab in the occurrence of CSDH and the efficacy of the neuroendoscopic approach in the surgical treatment of organized CSDH.

Subdural hematoma in a patient taking imatinib for GIST

“…Bevacizumab is a monoclonal antibody used in the treatment of certain cancer types because of its action on vascular endothelial growth factor [8]. Several links between bevacizumab and central nervous system hemorrhage have been reported.…”

“…Several links between bevacizumab and central nervous system hemorrhage have been reported. Takahashi et al [8] reported a case of a 78-year-old patient with colon cancer who was treated with an undescribed chemotherapeutic and bevacizumab and was found to have a chronic SDH on a follow-up PET scan. The patient underwent burrhole drainage initially, but after the hematoma failed to drain, it was evacuated.…”

“…The patient underwent burrhole drainage initially, but after the hematoma failed to drain, it was evacuated. There was no discussion on the causal mechanism [8]. Wong et al [9] reported on two patients with metastatic breast cancer to the brain, one treated with bevacizumab and the other with sunitinib (a TK inhibitor that targets the vascular endothelial growth factor receptor).…”

Meningioma mimics chronic subdural hematoma

“…[2][3][4] In contrast, hyperostosis is a common consequence of adjacent or invasive meningiomas. However, the uncommon thickening of the skull indicated a complication.…”

“…[1][2][3][4] OCFs can easily be missed because of their highly variable and usually nonspecific clinical features. On account of a greater awareness and widespread use of computed tomographic (CT) scanning, OCF is being reported more frequently.…”