The drainage tube into the dural-outer membrane space during burr hole evacuation for chronic subdural hematoma: Novel case report of 2 patients
Abstract
Rationale: During burr hole evacuation for chronic subdural hematoma (cSDH), the drainage catheter may inadvertently enter the potential space between the dura mater and the hematoma's outer membrane (dural-outer membrane (DOM) space), an unrecognized complication. This misplacement can lead to inadequate drainage, delayed recovery, and recurrence. This report describes 2 cases illustrating this phenomenon and aims to raise awareness and propose preventative strategies.
Patient concerns: Two male patients (mean age: 77 years) presented with symptoms including limb weakness, headache, or dizziness.
Diagnoses: Computed tomography scans revealed that case 1 had bilateral frontotemporoparietal high-density subdural hematomas, while case 2 exhibited a trabecular-septated subdural hematoma in the right frontotemporal region. The preoperative diagnosis was chronic subdural hematoma (possibly with intracranial hypertension).
Interventions: Preoperative evaluation localized the hematoma, and burr hole evacuation was performed at the site of maximum thickness. Postoperatively, minimal or no hematoma drainage was observed in both patients. One patient experienced hematoma recurrence, while the other had prolonged hospitalization and delayed symptom resolution.
Outcomes: Retrospective analysis of the surgical procedures, imaging studies, and clinical outcomes confirmed that the drainage catheter had entered the DOM space in both cases. This misplacement was identified as the cause of…
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