Use of Subdural Evacuating Port System Following Open Craniotomy with Excision of Native Dura and Membranes for Management of Chronic Subdural Hematoma.

Tene Cage,Ashley Bach,Michael W Mcdermott

doi:10.7759/cureus.1197

Abstract

An 86-year-old woman was admitted to the intensive care unit with a chronic subdural hematoma (CSDH) and rapid onset of worsening neurological symptoms. She was taken to the operating room for a mini-craniotomy for evacuation of the CSDH including excision of the dura and CSDH membrane. Postoperatively, a subdural evacuation port system (SEPS) was integrated into the craniotomy site and left in place rather than a traditional subdural catheter drain to evacuate the subdural space postoperatively. The patient had a good recovery and improvement of symptoms after evacuation and remained clinically well after the SEPS was removed. We offer the technique of dura and CSDH membrane excision plus SEPS drain as an effective postoperative alternative to the standard craniotomy leaving the native dura intact with traditional subdural drain that overlies the cortical surface of the brain in treating patients with CSDH.

Highlights

The incidence of chronic subdural hematomas (CSDH) in the general population has been rising, which is in part due to an increase in the elderly population and an increase in the use of oral antiplatelet and anticoagulation agents in this group of patients [1,2]
The subdural evacuating port system (SEPS) device provides postoperative drainage of the subdural space without a rubber drain or catheter lying over the brain or in the subdural space that could potentially cause bleeding from shearing of subdural and cortical vessels
Prior to removal of the SEPS drain postoperatively, the output should be carefully monitored and a computed tomography (CT) scan obtained to evaluate the remaining subdural collection to determine if further intervention such as repeat burr holes or craniotomy is necessary for CSDH resolution

Summary

Introduction

The incidence of chronic subdural hematomas (CSDH) in the general population has been rising, which is in part due to an increase in the elderly population and an increase in the use of oral antiplatelet and anticoagulation agents in this group of patients [1,2]. We present the case of a patient who required a craniotomy for subacute on CSDH evacuation, excision of the dura and outer CSDH membrane, and placement of SEPS drain integrated into the craniotomy for postoperative subdural drainage. Preoperative non-contrast CT scan (A,B), T1 weighted (C), and T2-weighted (D) MRI scans demonstrating subacute on early chronic left convexity subdural hematoma causing local mass effect and left to right midline shift. On examination at the initial time of evaluation, the patient was awake and attentive, but was oriented only to person and her speech output was markedly slowed Though she was able to name objects, count, and calculate, she displayed some difficulty with repetition. She had no signs of external trauma and denied any localized pain

Procedures

Discussion

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Disclosures