Novel Use of Dual-Lumen Catheter for Irrigation and Drainage After Evacuation of Chronic Subdural Hematoma

Abstract

Background: Chronic subdural hematoma (cSDH) is an intracranial pathology most commonly affecting elderly patients. Patients may present with worsening headache, seizures, weakness, balance and gait problems, and memory deficits. Even in patients undergoing hematoma evacuation, there is a substantial risk for recurrence. The authors present the first use of an irrigating external ventricular drain in the United States in the perioperative management of a patient with cSDH treated with craniotomy (IRRAS, Stockholm, Sweden).

Case description: An 82-year-old male presented with right-sided weakness, confusion, and right-sided neglect with expressive aphasia. He was found to have a large 2.5-cm cSDH with a 9-mm left-to-right midline shift. The patient was treated with a minicraniotomy to evacuate the hematoma and placement of an irrigating drain in the subdural space. The patient was discharged home on postoperative day 3 without complication. He was at neurologic baseline 2 weeks later on follow-up.

Conclusions: The use of an irrigating drain for perioperative management of cSDH is a novel means to prevent recurrence and warrants further exploration.

Keywords: Chronic; Drain; Evacuation; Hematoma; Subdural.