Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma / 대한신경손상학회지

Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

Delayed Cerebellar Hemorrhage after Supratentorial Burr-Hole Drainage

We report two cases with delayed cerebellar hemorrhage developed after supratentorial burr-hole drainage, and review the literature. Burr-hole drainage was performed at both sides of bilateral chronic subdural hematomas. The total amount of drainage per day was more than 300ml of hematoma mixed with cerebrospinal fluid(CSF) and the differences in doses between the two sides were significant in both cases. The symptoms improved after drainage but abrupt deterioration of neurological status occurred with the development of cerebellar hemorrhage on postoperative day 4 and 5, in each case. Although both patients were elderly, 75 and 86 years old, they did not have any coagulation defect or episode of severe increase in their blood pressures during drainage. We believe that suprate-ntorial CSF overdrainage can cause cerebellar upward shift, with resultant injury of weakened cerebellar vessels in old age.