Medicine · 2025
The drainage tube into the dural-outer membrane space during burr hole evacuation for chronic subdural hematoma: Novel case report of 2 patients.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wang Cheng, Zhou Kun, Chen Junquan, Qian Jiacai, Zhou Chengming, Deng Xiaopeng, Du Xiaolin
Аннотация
RATIONALE: During burr hole evacuation for chronic subdural hematoma (cSDH), the drainage catheter may inadvertently enter the potential space between the dura mater and the hematoma's outer membrane (dural-outer membrane (DOM) space), an unrecognized complication. This misplacement can lead to inadequate drainage, delayed recovery, and recurrence. This report describes 2 cases illustrating this phenomenon and aims to raise awareness and propose preventative strategies.
PATIENT CONCERNS: Two male patients (mean age: 77 years) presented with symptoms including limb weakness, headache, or dizziness.
DIAGNOSES: Computed tomography scans revealed that case 1 had bilateral frontotemporoparietal high-density subdural hematomas, while case 2 exhibited a trabecular-septated subdural hematoma in the right frontotemporal region. The preoperative diagnosis was chronic subdural hematoma (possibly with intracranial hypertension).
INTERVENTIONS: Preoperative evaluation localized the hematoma, and burr hole evacuation was performed at the site of maximum thickness. Postoperatively, minimal or no hematoma drainage was observed in both patients. One patient experienced hematoma recurrence, while the other had prolonged hospitalization and delayed symptom resolution.
OUTCOMES: Retrospective analysis of the surgical procedures, imaging studies, and clinical outcomes confirmed that the drainage catheter had entered the DOM space in both cases. This misplacement was identified as the cause of the poor drainage and adverse outcomes.
LESSONS: Recognizing the risk of catheter misplacement into the DOM space during burr-hole evacuation is essential, as it can significantly impair therapeutic efficacy. To our knowledge, this is the first report documenting catheter entry into the DOM space. The clinical insights and preventative measures proposed here may help avoid this complication and improve surgical outcomes in future cases.
PATIENT CONCERNS: Two male patients (mean age: 77 years) presented with symptoms including limb weakness, headache, or dizziness.
DIAGNOSES: Computed tomography scans revealed that case 1 had bilateral frontotemporoparietal high-density subdural hematomas, while case 2 exhibited a trabecular-septated subdural hematoma in the right frontotemporal region. The preoperative diagnosis was chronic subdural hematoma (possibly with intracranial hypertension).
INTERVENTIONS: Preoperative evaluation localized the hematoma, and burr hole evacuation was performed at the site of maximum thickness. Postoperatively, minimal or no hematoma drainage was observed in both patients. One patient experienced hematoma recurrence, while the other had prolonged hospitalization and delayed symptom resolution.
OUTCOMES: Retrospective analysis of the surgical procedures, imaging studies, and clinical outcomes confirmed that the drainage catheter had entered the DOM space in both cases. This misplacement was identified as the cause of the poor drainage and adverse outcomes.
LESSONS: Recognizing the risk of catheter misplacement into the DOM space during burr-hole evacuation is essential, as it can significantly impair therapeutic efficacy. To our knowledge, this is the first report documenting catheter entry into the DOM space. The clinical insights and preventative measures proposed here may help avoid this complication and improve surgical outcomes in future cases.