Usage of neuronavigation system to treat a case of traumatic acute subdural hematoma after two-side ventriculoperitoneal shunt

Abstract

Traumatic acute subdural hematoma is one of the most lethal causes of head injuries, which leads to high mortality. While combined diseases always make it more intractable for the treatment. We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12, 2017. She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus, with the ventriculoperitoneal shunt device on the right side out of work. The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect. A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma, with compression of the lateral ventricle (2.6 cm thick) and a 0.5 cm midline shift. To protect the ventriculoperitoneal shunt device, we used neuronavigation system to precisely mark the relative location of the device and “invisible” subdural hematoma, thus to design a perfect incision preoperatively. Subsequently, evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device. Postoperative CT of the head showed totally removing of the subdural hematoma. The patient recovered three months later. With the assistant of neuronavigation system, it is much easier for the preoperative planning and to reduce the surgical risk. Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases.