A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation

Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy. Human Neurosciences Department, Università degli Studi di Roma La Sapienza Facoltà di Medicina e Odontoiatria, Roma, Italy. Department of Neurosurgery, NEUROMED, Pozzilli, Molise, Italy. Department of Neurosurgery, Azienda Ospedaliera Cannizzaro, Catania, Sicilia, Italy. Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Sicilia, Italy. Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria.

Journal of neurological surgery. Part A, Central European neurosurgery. 2021
BACKGROUND  Remote intracerebral hemorrhage (RICH) is a severe complication following chronic subdural hematoma (cSDH) drainage, and only case reports and small case series have been reported to date. The authors present an emblematic patient affected by RICH following cSDH drainage. A systematic review of the literature on diagnosis and management of patients affected by RICH following cSDH evacuation has also been performed. METHODS  A literature search according to the PRISMA statement was conducted using PubMed and Scopus databases with the following Mesh terms: [(remote) AND (intracerebral hemorrhage or cerebral hematoma or cerebral infarction or cerebellar hemorrhage or cerebellar hematoma or cerebellar infarction) AND (chronic subdural hematoma)]. RESULTS  The literature search yielded 35 results, and 25 articles met our inclusion criteria: 22 articles were case reports and 3 were case series including three to six patients. Overall, 37 patients were included in the study. Age was reported in all 37 patients, 26 males (70.3%) and 11 females (29.7%), with a male-to-female ratio of 2.4:1. The mean age at diagnosis was 64.6 years (range: 0.25-86 years). Only in 5 cases (13.5%) did the ICH occur contralaterally to the previously drained cSDH. The rapidity of drainage can lead to several types of intracranial hemorrhages, caused by a too rapid change in the cerebral blood flow (CBF) and/or tears of bridging veins. The average time interval between cSDH drainage and neurologic deterioration was 71.05 hours (range: 0-192 hours). CONCLUSIONS  RICH following cSDH represents a rare occurrence and a serious complication, associated with elevated morbidity. Careful monitoring of drain speed after cSDH evacuation surgery is recommended, and minimally invasive techniques such as twist drill craniostomy are suggested, especially for massive cSDHs.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine