Organized Chronic Subdural Hematoma Requiring Craniotomy

Abstract

Two child and three elderly patients underwent craniotomy for organized and/or partially calcified chronic subdural hematomas (CSHs). The characteristic feature of magnetic resonance imaging was a heterogeneous web-like structure in the hematoma cavity. Both children had undergone one side subduroperitoneal shunt for bilateral CSHs when infants. As a result, the opposite hematoma cavities persisted and developed into calcified CSHs after a couple of years. All three elderly patients with senile brain atrophy showed various systemic complications such as cerebral infarction, diabetes mellitus, leg ulceration, cirrhosis, and bleeding tendency. Craniotomy for removal of the hematoma and calcification achieved good results in all patients. Subdural space created by shunt, craniotomy, or brain atrophy and persisting for a certain period, and additional various brain damage such as microcirculatory disorder, meningitis, encephalitis, or premature delivery may be important in generating calcified or organized CSH.

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

“…The causes of treatment failure include the presence of nonliquefied hematomas with various bleeding foci 14) ; multilayer loculations within the hematoma, which produce noncommunicating compartments 22) ; and excessive formation of a solid membranes 5) . Occasionally, advanced age has been considered to be a risk factor for recurrence and reoperation 19,20) .…”

“…The authors emphasized that it was important to remove the organized CSDH and the outer membrane in proportion to the hematoma expansion. Imaizumi et al 5) reported five cases of an organized CSDH, and proposed that a large craniotomy was the best treatment for calcified or organized CSDH associated with progressive symptoms. In our eight cases of organized/calcified CSDH, we performed large craniotomy with extended membranectomy; these cases required no reoperation and postoperative results were excellent.…”

“…The reasons why this type of hematoma occurs frequently among the elderly include an increase in antithrombotic medications, venous fragility, augmentation of the subdural space, and an increased exposure to traumatic injury resulting from frequent falls 1) . For the initial management of CSDH, numerous surgical treatments have been proposed 5,14,15,18,21) . However, the extent of surgical treatment required for CSDH is still controversial 2,24) , and the optimal treatment for CSDH is not well defined 16) .…”

“…Conversely, craniotomy is generally accepted as the optimal approach for reaccumulation of a CSDH, existence of a solid hematoma, failure of brain reexpansion, or marked swelling subjacent to the hematoma 5,14) . The purpose of this study was to analyze the efficacy of small or large craniotomy with membranectomy as the initial treatment for CSDH.…”

Armored brain in patients with hydrocephalus after shunt surgery; review of the literatures

“…This was an 11-year-old child with the typical dense shadow of calcification under the cranial vault on the left side (8). Calcifications occur in the membranes of chronic subdural hematoma in the range of 0.3% to 2.7% (5,10,18). Although usually seen in posttraumatic subdural hematoma, they have been reported in patient with post-meningitic effusion and in patients with hydrocephalus after ventriculoperitoneal shunt (10).…”