case_images: PMC10783685_01
case_images: Non-contrast head computed tomography scan, axial slices: (a) infratentorial bilateral acute subdural hematoma (SDH) with SDH and possibly some subarachnoid hemorrhage left temporally, (b) infratentorial SDH with similar density as temporal part of supratentorial SDH, (c) parietooccipital part of SDH, (d) frontal part of SDH, and (e) non-contrast head computed tomography scan, coronal slice, different densities of intratentorial, and supratentorial SDH can be appreciated.
case_images: SNI-14-413-g001.jpg
case_images: PMC10783685_01_SNI-14-413-g001.jpg
case_images: F1
case_images: Head computed tomography (CT) scan revealed a mostly lamellar aSDH over the left hemisphere without any compression on the brain parenchyma [Figure 1].
case_images: Non-contrast head computed tomography (CT) scan: (a) axial slice, bilateral chronic subdural hematoma (cSDH) in posterior fossa compressing cerebellum, fourth ventricle and brainstem, (b) coronal slice showing supratentorial and infratentorial cSDH, (c) sagittal slice CT scan showing infratentorial cSDH compressing cerebellum and brainstem, and (d) axial slice, ballooning of frontal horns of the lateral ventricles with transependymal effusion and rounding of the third ventricle.
case_images: SNI-14-413-g002.jpg
case_images: PMC10783685_01_SNI-14-413-g002.jpg
case_images: F2
case_images: A new head CT scan [Figure 2] verified the conversion of aSDH to cSDH, with partial regression of the supratentorial part.
case_images: Neurosurgical procedure. (a) Patient positioned supine with head turned left, incision mark over the superior nuchal line, (b) two large burr-hole trepanations made each on its respective side, (c) cross-shaped dural incision with hematoma evacuation, (d) placement of subdural drains in their respective sides, and (e) subcutaneously tunneled subdural drains (at least 5 cm from the burr holes).
case_images: SNI-14-413-g003.jpg
case_images: PMC10783685_01_SNI-14-413-g003.jpg
case_images: F3
case_images: The patient was operated on [Figure 3] under general anesthesia, in a supine position with the head turned to the left side.
case_images: Non-contrast head computed tomography scan. (a) Coronal slice showing the position of subdural drains underneath the cerebellum bilaterally, (b) sagittal slice confirming the position of subdural drain underneath the cerebellum, (c) axial slice at the level of the fourth ventricle showing the initial phase of its reexpansion, subdural drains are placed bilaterally, posterior to the cerebellum, and (d) partial reconstruction of the posterior fossa showing the placement of subdural drains.
case_images: SNI-14-413-g004.jpg
case_images: PMC10783685_01_SNI-14-413-g004.jpg
case_images: F4
case_images: A control head CT scan done the day after the procedure confirmed a satisfactory position of subdural drains with a regressive dynamic of posterior fossa cSDH and hydrocephalus [Figure 4].
case_images: Non-contrast head computed tomography scan, axial slices: (a) regression of chronic subdural hematoma of the posterior fossa with a visible burr hole on the right occipital bone, (b) re-expanded fourth ventricle, and (c and d) regression of hydrocephalus.
case_images: SNI-14-413-g005.jpg
case_images: PMC10783685_01_SNI-14-413-g005.jpg
case_images: F5
case_images: Subdural drains were removed three days after the operation, and a control CT scan showed no signs of new bleeding [Figure 5].