Spontaneous Development of Encapsulated Subdural Hematoma in the Posterior Cranial Fossa after Cardiac Surgery: A Case Report

Kochi, Ryuzaburo; Mino, Masaki; Sonobe, Shinya; Yoshida, Masahiro; Tominaga, Teiji

doi:10.2176/nmccrj.cr.2017-0230

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…However, since the number of reports is limited, the optimal treatment is unknown. [ 4 ] In the present case, considering that the patient was in use of anticoagulant therapy, a less invasive burr hole surgery was indicated to reduce the risk of postoperative bleeding and we had an excellent outcome with complete resolution of symptoms and postoperative CT demonstrating resolution of the pathology.…”

Section: Discussionmentioning

confidence: 83%

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Spontaneous chronic subdural hematoma of the posterior fossa: A case report

Zemel¹,

Meguins²,

Caramanti³

et al. 2022

Surgical Neurology International

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Background: Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare and only a few cases have been reported in the literature. We report a case of CSH in the posterior fossa successfully treated with a single burr hole surgery. Case Description: A 66-year-old woman who underwent anticoagulation therapy and was suffering, in the past 3 weeks from headache, vertigo, and gait ataxia. Screening with magnetic resonance imaging demonstrated infratentorial CSH on the right cerebellar hemisphere. Coagulation was normalized and the hematoma was evacuated through a burr hole irrigation. The symptoms resolved completely within a few days. Postoperative computed tomography showed a normal postoperative appearance and resolution of hematoma. She was discharged 1 week later without any neurological deficits. Conclusion: CSH in the posterior fossa is an extremely rare condition. Due to the limited number of reports, the optimal treatment is yet unknown. In cases with coagulation disorders, less invasive and early treatment should be considered. More studies are needed to define the best management for this pathology and cases must be individualized according to each patient’s particularities.

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Section: Discussionmentioning

confidence: 83%

“…In some cases, no cause is found. [ 4 ] Furthermore, a CSH could be the result of a transformation of an acute one. The predominant manifestations are headaches, vomiting, cerebellar symptoms, and cranial nerve dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous chronic subdural hematoma of the posterior fossa: A case report

Zemel¹,

Meguins²,

Caramanti³

et al. 2022

Surgical Neurology International

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“…Kochi et al have reviewed rare cases of spontaneous posterior fossa CSDH and reported that 12 out of the 13 cases (92.3%) were female patients. 21 ) The reason for female predominance is unclear, but sexual anatomical features and/or vascular differences might exist in the posterior fossa.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery

Kikuchi

Orito

Sakata

et al. 2022

Neurol. Med. Chir.(Tokyo)

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As posterior fossa acute subdural hematoma (ASDH) right after cardiac surgery is extremely rare, the clinical course and optimal treatment strategy remain undetermined. We performed a retrospective analysis of patients with posterior fossa ASDH right after cardiac surgery requiring neurosurgical treatment at our institution over a 7-year period and, in this study, discussed the neurosurgical strategy and clinical course. Collected data included clinical history, laboratory results, time course, symptoms, neurosurgical treatment, outcome at discharge, and imaging studies. All six patients were women who had no history of head trauma and had received antithrombotic therapy during the perioperative period of cardiac surgery. All patients showed lower platelets count and were diagnosed with ASDH within 3 days (longest time 64 h) right after cardiac surgery. After discontinuation of anticoagulation therapy and administration of reversal agents, they underwent emergency hematoma evacuation craniotomy (n = 5) or burr hole drainage surgery (n = 1), which were performed in the prone (n = 4) or lateral (n = 2) positions. Four of these patients showed favorable outcomes, and two showed poor outcomes. One of the poor-outcome patients received three antithrombotic therapies, and another developed rapidly progressive ASDH. Posterior fossa ASDH associated with antithrombotic therapy right after cardiac surgery is frequently found in women, and emergent neurosurgical treatment with anticoagulation discontinuation and reversal agent administration can be performed safely. Burr hole drainage surgery might be acceptable in nonsevere cases. By contrast, we must pay attention to cases receiving both anticoagulant and antiplatelet drugs and rapid progression cases.

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Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

Quiñones-Ossa,

Maurya,

Deivasigamani

et al. 2023

J Neurointensive Care

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Chronic subdural hematoma (CSDH) is a common neurosurgical disease encountered by neurologists, neurosurgeons, intensive care specialists, and emergency physicians in the emergency department. Although much has been published on CSDH, it remains a topic of active research, also a significant challenge in specific scenarios. The spectrum of clinical presentation varies from asymptomatic radiological entity to significant sensory-motor deterioration resulting in a comatose state. The majority of these cases have an underlying history of trivial trauma in one or the other form. More often, elderly individuals present with CSDH. Management of CSDH in elderly individuals presents specific challenges due to pre-existing comorbidities and medications which alter the pathophysiology. There exists a significant diversity in the treatment modality of CSDH amongst neurosurgeons. The treatment modality includes medical management as well as various forms of surgical manoeuvres intended to evacuate the hematoma and hence alleviate the mass effect over the surrounding brain matter. The treatment modality needs to be individualized for every case. The rationale selection of cases for medical and surgical intervention with robust follow-up results in a better prognostication of these cases.

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Spontaneous Development of Encapsulated Subdural Hematoma in the Posterior Cranial Fossa after Cardiac Surgery: A Case Report

Cited by 3 publications

References 19 publications

Spontaneous chronic subdural hematoma of the posterior fossa: A case report

Spontaneous chronic subdural hematoma of the posterior fossa: A case report

Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery

Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

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