Subdural-peritoneal shunt: treatment for bilateral chronic subdural hematoma.

BACKGROUND: Various modalities have been advocated and practiced to maximize the effectiveness of treatment for chronic subdural hematoma. Most patients with chronic subdural hematoma are successfully treated with simple burr-hole evacuation and external drainage. Hematomas with thick membranes have been found to persist or recur, sometimes necessitating reoperation or major surgery; however, they have been satisfactorily treated by repeated drainage or tapping as well. Chronic subdural hematoma can sometimes become an intractable and difficult problem. In recurring chronic collections, subdural-peritoneal shunts have been used as a mode of treatment. Treatment of recurrent subdural collection in infants has been successfully achieved by using subdural-peritoneal shunts. There is also literature to support a similar treatment for recurrent chronic subdural hematoma in older patients. CASE DESCRIPTION: We report a case of recurrent bilateral chronic subdural hematoma in an adult, which was successfully managed by repeated burr-hole evacuation initially, followed by insertion of a subdural-peritoneal shunt. The patient did well clinically, and computerized axial tomography did not reveal any subdural collection on follow-up.
CONCLUSION: Treatment of recurrent chronic subdural hematoma is usually straightforward; however, it can sometimes be refractory to regular treatment. In managing such cases, we recommend placement of a subdural-peritoneal shunt in preference to a more complicated craniotomy and membranectomy.