Giant Globular (Biconvex) Chronic Subdural Hematoma

Abstract

Introduction Hydrocephalus is a frequent neurological condition in childhood. The most common approach to this disease is still ventricular shunting. However, shunting problems, including catheter infection or shunting malfunctioning, contribute to several complications, such as extra-axial hematomas, which are a possibly life-threatening. Case report We report the case of a 6-month-old female infant victim of brain trauma. She was previously shunted because of an obstructive hydrocephalus consequent of an aqueductal stenosis diagnosed early after birth. After brain injury, initial symptoms were only irritability and horizontal nystagmus. A computed tomography scan revealed an extra-axial mass lesion that suggested a giant globular extradural hematoma. The patient was submitted to a small exploratory craniectomy to evacuate the blood clot. Surprisingly, the supposed extradural hematoma was, in fact, a chronic subdural hematoma with an unusual shape. After the surgical drainage, the patient remained asymptomatic. No lesion recurrence has been detected so far. Conclusions The case illustrates a very uncommon and interesting presentation of a common neurosurgical disease. A full characterization of the lesion and its pathophysiology is made, and a particular surgical management is proposed and thoroughly discussed.