Subarachnoid hemorrhage developing during burr-hole irrigation for the treatment of chronic subdural hematoma

Abstract

A 68-year-old man who developed subarachnoid hemorrhage (SAH) during irrigation for the treatment of chronic subdural hematoma is reported. The cause of this rare complication was presumed to be tearing of small vessels in the subarachnoid space by evacuation of the subudural hematoma associated with rupture of the hematoma membrane resulting from inadequate insertion of the irrigation catheter. This case indicates that subarachnoid hemorrhage during evacuation of a hematoma by burr-hole irrigation with a catheter must be listed as a complication of evacuating surgery for chronic subdural hematoma. Care must be taken to prevent SAH during the surgery, with careful insertion of the catheter to avoid rupturing the inner membrane of the hematoma and care must also be taken to avoid sudden evacuation of the hematoma that may induce a pressure difference or distortion between the supra and infra tentorial fossa, especially in patients suffering from hypertension, arteriosclerosis, unruptured aneurysm and advanced age.