Managing subdural hematomas associated with intracranial hypotension with intra-subdural hematoma cavity pressure monitoring:A case report

Abstract

Subdural hematomas(SDHs)are common radiographic findings in patients with intracranial hypotension(IH). The pathophysiological features of this condition are complicated, and are quite different in each case. In some cases, only treatment for an underlying cerebrospinal fluid leak is needed. However, some SDHs have an obvious mass effect, and hematoma evacuation is required before or after treatment for the underlying IH. Thus, the optimal management technique for this condition remains challenging. We hypothesize that by measuring the intra-SDH cavity pressure we can discern the pathophysiological features of this condition, which is the key to optimal management of these SDHs. We herein report a novel management technique for a case of bilateral SDHs associated with IH in which an intracranial pressure sensor and drainage tube were simultaneously inserted into the hematoma cavity. As a result, the intra- SDH cavity pressure accurately revealed the pathophysiological condition of this case and therefore an appropriate treatment could be performed. We postulate that the management technique described in this report can be applied in cases of bilateral SDHs associated with IH when conservative therapies have failed.