Open Access

Determination of a ‘point of no return’ in refractory chronic subdural hematomas: A case report and review of the literature

  • Authors:
    • Alexandros G. Brotis
    • George Fotakopoulos
    • Vasiliki Epameinondas Georgakopoulou
    • Adamantios Kalogeras
    • Theodosis Spiliotopoulos
    • Ioannis Ioannidis
    • Kostas N. Fountas
  • View Affiliations

  • Published online on: October 10, 2024     https://doi.org/10.3892/mi.2024.199
  • Article Number: 75
  • Copyright : © Brotis et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

Recurrence following the surgical evacuation of a chronic subdural hematoma (CSDH) occurs in up to 33% of cases. Several clinical and radiologic factors have been identified that are associated with the recurrence of hematoma. However, the optimal treatment for recurrent CSDH has not yet been determined. The present study, based on a case report, reviews the predictors and treatment options for refractory CSDHs. An 85‑year‑old male patient presented with a symptomatic bilateral CSDH. The hematoma was initially removed through a burr hole and closed drainage system, resulting in clinical improvement and in the radiographic resolution of the hematoma. At the first recurrence, steroids were administered and the hematoma was re‑evacuated. After 1 month, the patient returned comatose due to a massive right subdural hematoma and was treated with an ipsilateral craniotomy and a membranectomy. After 2 days, the patient succumbed due to massive intraparenchymal bleeding. The treatment of refractory CSDHs is challenging. The failure of brain re‑expansion and senile atrophy appear to be the key predictors of recurrence. Patients who are at high‑risk need to be identified promptly and treated with a multidisciplinary approach that considers adjuvant medications, middle meningeal artery embolization and repeat hematoma evacuation, probably with a membranectomy and an endoscope.
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Spandidos Publications style
Brotis AG, Fotakopoulos G, Georgakopoulou VE, Kalogeras A, Spiliotopoulos T, Ioannidis I and Fountas KN: Determination of a ‘point of no return’ in refractory chronic subdural hematomas: A case report and review of the literature. Med Int 4: 75, 2024.
APA
Brotis, A.G., Fotakopoulos, G., Georgakopoulou, V.E., Kalogeras, A., Spiliotopoulos, T., Ioannidis, I., & Fountas, K.N. (2024). Determination of a ‘point of no return’ in refractory chronic subdural hematomas: A case report and review of the literature. Medicine International, 4, 75. https://doi.org/10.3892/mi.2024.199
MLA
Brotis, A. G., Fotakopoulos, G., Georgakopoulou, V. E., Kalogeras, A., Spiliotopoulos, T., Ioannidis, I., Fountas, K. N."Determination of a ‘point of no return’ in refractory chronic subdural hematomas: A case report and review of the literature". Medicine International 4.6 (2024): 75.
Chicago
Brotis, A. G., Fotakopoulos, G., Georgakopoulou, V. E., Kalogeras, A., Spiliotopoulos, T., Ioannidis, I., Fountas, K. N."Determination of a ‘point of no return’ in refractory chronic subdural hematomas: A case report and review of the literature". Medicine International 4, no. 6 (2024): 75. https://doi.org/10.3892/mi.2024.199