Implementation of irrigating drainage systems after burr hole evacuation of bilateral subdural hematomas leads to reduction in postoperative pneumocephalus and improved brain re-expansion – A case report
| Autor: | Alvin Y. Chan, Jordan Davies, Diem Kieu Tran, Alexander S Himstead, Sumeet Vadera, Jefferson W. Chen |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Neuroscience (miscellaneous) Physical examination Emergency department medicine.disease Subdural Hematomas Surgery Lethargy Hematoma Pneumocephalus Neurology medicine Neurology (clinical) Drainage business Reduction (orthopedic surgery) |
| Zdroj: | Brain Hemorrhages. 3:131-134 |
| ISSN: | 2589-238X |
| DOI: | 10.1016/j.hest.2021.04.003 |
| Popis: | Background and importance Chronic subdural hematoma (cSDH) is a common neurosurgical pathology with a projected increase in prevalence as the elderly population grows. We describe a novel implementation of the IRRAflow irrigating drainage system after burr hole evacuation of bilateral acute-on-chronic subdural hematomas that demonstrates the benefits of this system for common post-operative challenges of these surgeries. Clinical presentation An 83-year-old male presented to the emergency department with 3 weeks of progressive weakness, lethargy, and confusion following an unwitnessed fall. Physical examination was notable for pupillary asymmetry and altered mental status. Computed tomography (CT) of the head showed bilateral acute-on-chronic subdural hematomas. The patient underwent bilateral burr hole evacuation and placement of IRRAflow irrigating drains. Postoperative head CT demonstrated poor brain re-expansion with significant bilateral pneumocephalus. Marked improvement in brain re-expansion occurred with continuous irrigation and drainage, and the patient was discharged on postoperative day (POD) 3 with return to neurological baseline. He followed up on POD13 in stable condition. Conclusion This report described a patient with bilateral subdural hematomas who underwent evacuation and bilateral IRRAflow dual-lumen catheter placement. Significant postoperative pneumocephalus improved rapidly with continuous irrigation and drainage, leading to improved brain re-expansion, hematoma resolution, and excellent neurological recovery. |
| Databáze: | OpenAIRE |
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