case_images: PMC11302598_01
case_images: (a) Preoperative and (b) postoperative images showing progressive disappearance of the subdural collection at one day, (c) eight days and (d) 9 weeks following the left pterional burr.
case_images: SNI-15-254-g002.jpg
case_images: PMC11302598_01_SNI-15-254-g002.jpg
case_images: F2
case_images: The computed tomography (CT) scan of the head showed recollections of bilateral subdural hematomas, much larger on the left, producing a mass effect and left-to-right midline shift [Figure 2a]. Sequential postoperative CT scans performed on days 1, 8, and 9 weeks after surgery demonstrated progressive resolution of the subdural collections [Figure 2b-d].
case_images: PMC11302598_02
case_images: (a) Navigation landmarks to locate the burr hole placement: coronal and (b) axial bone density CT slices showing the "open" groove (solid arrows), where the MMA leaves its intraosseous portion (hollow arrow on the contralateral side) to enter the calvarium.
case_images: SNI-15-254-g003.jpg
case_images: PMC11302598_03_SNI-15-254-g003.jpg
case_images: F3
case_images: The localization for the right burr hole at the pterional region was made by means of Stryker navigation, similar to the description for Case 2, as shown in Figure 3.
case_images: Sequential head CT scans: (a) Five weeks after the injury, when steroid therapy was attempted. (b) Four weeks later, when the symptoms remained unchanged. (c) Postoperative images one week after surgery and (d) four weeks after surgery.
case_images: SNI-15-254-g004.jpg
case_images: PMC11302598_02_SNI-15-254-g004.jpg
case_images: F4
case_images: Sequential CT scans showed the disappearance of the subdural collection by 4 weeks [Figure 4].
case_images: PMC11302598_03
case_images: (a) Navigation landmarks to locate the burr hole placement: coronal and (b) axial bone density CT slices showing the "open" groove (solid arrows), where the MMA leaves its intraosseous portion (hollow arrow on the contralateral side) to enter the calvarium.
case_images: SNI-15-254-g003.jpg
case_images: PMC11302598_03_SNI-15-254-g003.jpg
case_images: F3
case_images: The localization for the right burr hole at the pterional region was made by means of Stryker navigation, similar to the description for Case 2, as shown in Figure 3.
case_images: (a) CT prior to surgery. (b) Three weeks after right burr hole evacuation and MMA coagulation and (c) three months after the same procedure on the left side.
case_images: SNI-15-254-g005.jpg
case_images: PMC11302598_03_SNI-15-254-g005.jpg
case_images: F5
case_images: Repeat imaging revealed an increase in the size of the subdural collections, especially on the right, accompanied by increasing headaches [Figure 5a]. On an outpatient follow-up 3 months later, the patient remained asymptomatic, neurologically normal, and caring for himself at home [Figure 5c].
case_images: PMC11302598_04
case_images: (a) Sequential CT images at the time of injury and (b) two months later. (c) CT scout image of both burr holes: the pterional one (black arrow) over the groove of the MMA. (d) CT at four weeks postoperative.
case_images: SNI-15-254-g006.jpg
case_images: PMC11302598_04_SNI-15-254-g006.jpg
case_images: F6
case_images: The head CT showed a small left frontal hygroma [Figure 6a]. A follow-up head CT scan demonstrates the conversion of the left-sided hygroma into a CSH, with an increase in volume and signal intensity [Figure 6b]. This prompted the placement of a second parietal burr hole over the thickest portion of the subdural hematoma, resulting in satisfactory drainage of subdural fluid [Figure 6c]. CT scan of the head demonstrated complete resolution of the previously existent subdural hematoma [Figure 6d].
case_images: PMC11302598_05
case_images: PMC11302598_06
case_images: PMC11302598_07
case_images: PMC11302598_08
case_images: PMC11302598_09
case_images: (a) Sequential CT showing a preexistent right chronic subdural hematoma. (b and c) Following repeated falls, there was continued increase in the subdural collection of higher signal intensity, indicative of rebleeds. (d) Postoperative image ten weeks after surgery.
case_images: SNI-15-254-g007.jpg
case_images: PMC11302598_09_SNI-15-254-g007.jpg
case_images: F7
case_images: Sequential head CT scans revealed a preexistent (3 weeks earlier) right CSH on the same side as an atrophic brain from a previous large middle cerebral artery infarct [Figure 7a]. Immediately after the injury, this increased into a larger subdural collection of mixed signal intensity, indicative of acute rebleeding into an older chronic subdural collection and consistent with the history of repeated falls [Figure 7b]. There is further rebleeding 3 days later, which caused effacement of the right cerebral sulci over the convexity despite a large area of ipsilateral encephalomalacia [Figure 7c]. Postoperative imaging at 10 weeks was very satisfactory because, despite ipsilateral cerebral atrophy, there was complete resolution of the subdural collection [Figure 7d].