Abstract
There are several treatment modalities for the management of subdural fluid collection in infants, such as fontanelle puncture and drainage, burr hole irrigation, and subduroperitoneal shunt. This report describes the case of a girl born with congenital neurological impairment due to severe injury of the brain with unknown etiology. At five months of age, she suffered from head trauma and developed somnolence after three days and was diagnosed with a bilateral massive chronic subdural hematoma. Normal fundoscopy did not confirm the non-accidental head trauma. Neuroendoscopy using a single burr hole was performed and complete drainage was achieved. Arachnoid tearing was observed during the procedure. Postoperatively, the patient showed clinical improvement, and brain expansion was observed after one month. The main advantages of neuroendoscopy for bilateral massive chronic subdural hematoma are accurate visualization of the space, minimal invasiveness, and treatment of both sides with reliable drainage control.
Highlights
The management of subdural fluid collection in infants is controversial, and several treatment modalities have been reported, such as fontanelle puncture and drainage, burr hole irrigation, and subduroperitoneal shunt [1]
At five months of age, she suffered from head trauma and developed somnolence after three days and was diagnosed with a bilateral massive chronic subdural hematoma
Previous history examination showed that the patient was born with a diffuse brain lesion of no defined etiology, and computed tomography (CT) of the brain at two months showed a compromised brain and compensatory enlargement of lateral ventricles associated with a thin cortical mantle (Figure 1)
Summary
The management of subdural fluid collection in infants is controversial, and several treatment modalities have been reported, such as fontanelle puncture and drainage, burr hole irrigation, and subduroperitoneal shunt [1]. This report describe the case of an unusual massive bilateral chronic hematoma in a five-month-old girl that was successfully treated using neuroendoscopy via a single burr hole. The patient underwent CT and MRI of the brain, which showed a massive bilateral subdural hematoma with two hyperdense masses adherent to the collapsed brain (Figures 2-3). CT scan of the brain without contrast showing massive hypointense extracerebral fluid collection associated with hyperintense imaging, occupying the occipital region on the right side of the intracranial compartment (left). Axial T2-weighted MRI showed a peduncular hypointense mass in the collapsed brain and hyperintense subdural fluid collection (A). Axial T1-weighted MRI high-level slice showing a massive subdural hypo-/isointense mass collapsing the brain (E). Introducing the neuroendoscope into the right lateral intracranial subdural compartment shows hemorrhage and turbid liquid.
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