Abstract WP429: Therapeutic Strategy For Chronic Subdural Hematoma Associated With Cerebrospinal Fluid Hypovolemia

Abstract

Chronic subdural hematoma (CSH) with the cerebrospinal fluid (CSF) hypovolemia is often reported, but the therapeutic strategy is not established. We examined the therapeutic strategy and the treatment result for CSH with the CSF hypovolemia that we experienced in our hospital. [Object and method] In 544 patients with CSF hypovolemia during January 2000 to July 2012, 7 cases (1.3%) had CSH bilaterally. About CSF hypovolemia, 5 cases was diagnosed as spontaneous, 1 case as post-traumatic injury, and 1 case as post-traffic injury. We devided them into 3 groups; the first group which performed epidural blood patch (EBP) therapy first, the second group which performed hematoma evacuation for CSH first, and the third group group which performed the hematoma evacuation for CSH and EBP simultaneously. [Result] In the first group included 5 cases, only 1 case of CSH resolved spontaneously, and another 4 cases needed additional hematoma evacuation by aggravation of clinical symptoms. In the second group included 1 case, CSH recurred, and additional EBP therapy and hematoma evacuation were needed. In the third group included 1 case, the improvement of prompt clinical symptoms was obtained and CSH did not recurr. [Conclusion] The treatment for CSH with CSF hypovolemia needs EBP therapy first, however most cases needs an additional hematoma evacuation. If it takes into consideration, it may be better to do the hematoma evacuation and the EBP simultaneouly. In addition, it is necessary to consider a CSF hypovolemia as a cause of a bilateral CSH which relapse after treatment.