PMC5154205_01
CT scan on admission showing left CSDH with moderate rightward midline shift (left). CT scan obtained 1 day after first burr hole irrigation and drainage showing the hematoma is replaced with air collection (right)
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F1
Computed tomography (CT) revealed left CSDH with moderate rightward midline shift [Figure 1, left]. After removal of the hematoma with irrigation [Figure 1, right], a drainage tube was placed posteriorly.
CT scans before the second surgery (left) and the third surgery (right)
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F2
CT revealed recurrence of the CSDH [Figure 2, left]. CT showed recurrent CSDH [Figure 2, right], and hence we considered applying middle meningeal artery (MMA) embolization to him.
CT scans obtained before (left) and 1 day after (right) the fourth surgery. The tip of the drainage tube is placed on the frontal side and the subdural air collection is reduced compared to the finding after the first surgery (Figure 1, right)
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F3
Twenty-seven days after the third surgery, he suffered gait disturbance, and CT revealed recurrent CSDH [Figure 3 left]. The drain was placed anteriorly to reduce postoperative air collection [Figure 3, right].
CT scans obtained before (left) and 1 day after (right) the fifth surgery. The tip of the drainage tube is placed more anteriorly with thin subdural space with minimum air collection
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F4
Unfortunately, the CSDH recurred with mild right hemiparesis after 9 days [Figure 4, left]. On the following day, CT confirmed the collapsed hematoma cavity with minimum air collection [Figure 4, right].
The patient was placed in the left lateral position. Through the drainage tube, 12 ml of the residual hematoma was evacuated, and then they were injected in order of 5 ml of solution A of fibrin glue, few ml of saline, and 5 ml of solution B. Finally, the drainage tube was slowly pulled away during flushing with a few ml of saline
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F5
Finally, the drainage tube was slowly pulled away during flushing with a few ml of saline [Figure 5].
CT scans obtained 6 months after fibrin glue injection into the hematoma cavity. No further recurrence is apparent
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F6
No further recurrence was confirmed in 6 months after the treatment [Figure 6], and the patient has been free from symptoms for over 2 years.