case_images: PMC11789874_01
case_images: Imaging examination results of the patient. (A) The preoperative CT scan revealed a low-density subdural mass located in the right frontal, temporal, parietal, and occipital regions, causing a midline shift towards the contralateral side. (B) The preoperative T1 sequence revealed mixed signal shadows, predominantly exhibiting high signal intensity in the subdural region of the right frontal, temporal, parietal, and occipital lobes. (C) The preoperative T2 sequence revealed hypointense shadows between the lesion and the cerebral cortex, with no apparent edema signal surrounding the lesion. (D) No significant enhancement was detected within the lesion on the preoperative MR enhancement scan, with linear enhancement shadows noted along the lesion's periphery bordering the cerebral cortex. (E) The postoperative CT scan indicated the clearance of the right subdural hematoma and a reduction in midline structural deviation. (F) The postoperative CT localization film revealed both a small bone window craniotomy shadow and a large bone flap craniotomy shadow.
case_images: medi-104-e41260-g001.jpg
case_images: PMC11789874_01_medi-104-e41260-g001.jpg
case_images: F1
case_images: Contrast-enhanced MRI did not show significant enhancement within the lesion, although linear enhancement was observed at the lesion's border near the cerebral cortex (Fig. 1).
case_images: Intraoperative assessment of patient's condition. (A) During a small bone window craniotomy, an incision of the dura mater exposed a hard, light-yellow subcapsular layer beneath it, clearly demarcated from the dura mater. (B) Following the capsule incision, a layer measuring around 2 mm to 4 mm thick was identified, which held a minor quantity of aged bloody fluid and blood clots. (C) After removing bloody fluids and clots, a substantial quantity of solid yellow cheese-like substances was visible, accompanied by a limited blood supply. Some of these could be extracted using an aspirator. (D) After a craniotomy involving a large bone flap, the visceral capsule was observed to measure approximately 3 mm in thickness, appear gray-white, and exhibit a notable proliferation of capillaries on the cortical surface.
case_images: medi-104-e41260-g002.jpg
case_images: PMC11789874_01_medi-104-e41260-g002.jpg
case_images: F2
case_images: Figure 2 shows the patient's intraoperative condition.
case_images: Postoperative pathological assessment of the patient. (A) Through HE staining, the capsule wall exhibited fibrous tissue, blood clots, inflammatory cells, and hemosiderin deposition (x100). (B) Through HE staining, the capsule contents exhibited hyperplastic and hyaline fibrous connective tissue, blood clots, inflammatory necrosis, exudates, and focal foam-like tissue cell aggregation (x100).
case_images: medi-104-e41260-g003.jpg
case_images: PMC11789874_01_medi-104-e41260-g003.jpg
case_images: F3
case_images: Postoperative pathological examination (Fig. 3) of the capsule wall revealed fibrous cystic tissue with blood clots, inflammatory cells, and hemosiderin deposition.
case_images: The results of the head CT scan of the patient 1-year post-surgery. (A) The low-density subdural mass in the right frontal, temporal, parietal, and occipital regions was resolved. (B) The centerline structure was centered.
case_images: medi-104-e41260-g004.jpg
case_images: PMC11789874_01_medi-104-e41260-g004.jpg
case_images: F4
case_images: Additionally, the patient demonstrated normal muscle tone and muscle strength graded at level 5 in all limbs. A subsequent head CT scan (Fig. 4) revealed a significant decrease in the low-density mass located beneath the dura mater in the right frontal, temporal, parietal, and occipital regions, with a well-centered midline structure.