Remote hemorrhage after burr-hole surgery for chronic subdural hematoma: A report of two cases

Abstract

Background:The standard neurosurgical procedure for chronic subdural hematoma is a burr-hole surgery. Postoperative hemorrhage is one of the complications after burr-hole surgery. The hemorrhage generally occurs at the surgical site; however, remote hemorrhage is rare. Here, we report two cases of remote hemorrhage after burr-hole surgery for chronic subdural hematoma and discuss the possible mechanism underlying this rare complication.Case Description:Two patients presented remote hemorrhages after burrhole surgery for chronic subdural hematoma. In the first case, hemorrhage occurred in the interhemispheric fissure and contralateral subdural space. In the second case, hemorrhage occurred in the subdural space of the posterior fossa.Conclusion:Postoperative remote hemorrhage is a rare complication, and it can occur after both craniotomy surgery and burr-hole surgery. Neurosurgeons should consider the possibility of this rare complication, and sufficient care should be taken to select the most appropriate surgical procedure to prevent remote hemorrhage.

Rapid Spontaneous Resolution of Contralateral Lentiform Acute Subdural Hematoma After Burr Hole Trephination for Chronic Subdural Hematoma

“…When brain shift to the midline occurs too rapidly, contralateral bridging veins (BVs) that run between the dura and brain surface can be stretched and torn, resulting in ASDH. 2 5 6 8 15 16) Tear of BV has been confirmed in the cases where surgical treatment was performed to remove contralateral ASDH after BHT. 4 8 15) When there is brain atrophy, the subarachnoid space (SAS) and SDS can be widened and the distance between the dura and brain surface can increase, which can lead to more stretched BVs.…”

“… 9) In our literature review, CSDH or SH on the contralateral side of the burr hole site was present before BHT in 3 cases. 2 5 16) In these cases, as in the case of brain atrophy, the distance between the dura and brain surface increased. Thus, it was presumed that BVs had already been stretched before BHT.…”

“…Massive irrigation might be a cause of rapid brain shift and resultant tear of BV in the present case. Kaneshiro et al 5) have speculated in their case report that irrigation might change ICP rapidly. In our literature review, irrigation was performed in 4 out of 5 cases that mentioned whether or not irrigation was performed ( TABLE 1 ).…”

“…They are summarized in TABLE 1 . 2 4 5 6 8 15 16 18 19) After BHT and opening the dura and outer membrane of CSDH, as CSDH flows out through the burr hole, intracranial pressure (ICP) decreases, the brain compressed by CSDH is decompressed or expanded, and the brain that has shifted to the contralateral side returns to the midline. When brain shift to the midline occurs too rapidly, contralateral bridging veins (BVs) that run between the dura and brain surface can be stretched and torn, resulting in ASDH.…”

“… 2 3 13) Although contralateral ASDH after BHT is very rare, it is sometimes fatal. 5 18) Although the typical shape of subdural hematoma (SDH) on computed tomography (CT) scan is a crescent shape, sometimes SDH has a lentiform or biconvex shape that is typical of epidural hematoma (EDH) on CT scan. 11 14) In such case, SDH can be misdiagnosed as EDH.…”