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Chronic subdural hematoma following bypass surgery--report of three cases
Insights
Bypass surgery is generally safe, but chronic subdural hematoma (CSDH) can occur postoperatively. Avoiding early anticoagulant therapy may reduce CSDH risk in patients with brain atrophy and effusion.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Cerebral bypass surgery, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, is performed to restore blood flow in cerebrovascular diseases.
- While generally safe with low complication rates, potential adverse events require careful monitoring and management.
Observation:
- Three patients developed chronic subdural hematoma (CSDH) following bypass surgery.
- Two cases occurred after STA-MCA anastomosis for stroke, and one after STA-MCA anastomosis with encephalomyosynangiosis for moyamoya disease.
Findings:
- CSDH development post-revascularization appears linked to factors such as postoperative subdural effusion, pre-existing brain atrophy, and anticoagulant therapy (e.g., aspirin).
- Analysis of seven reported and present cases suggests a correlation between these factors and CSDH occurrence.
Implications:
- Patients with pre-existing brain atrophy and postoperative subdural effusion may be at higher risk for CSDH after bypass surgery.
- Early postoperative anticoagulant therapy should be carefully considered and potentially avoided to mitigate CSDH risk in these patients.
Abstract:
Bypass surgery is a safe procedure with low mortality and morbidity, and few reported surgical complications. Three patients developed postoperative chronic subdural hematoma (CSDH): two with stroke after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and one with moyamoya disease after STA-MCA anastomosis combined with encephalomyosynangiosis. The factors inducing CSDH after revascularization in the seven reported and present cases included postoperative subdural effusion associated with brain atrophy, and postoperative anticoagulant therapy such as aspirin. CSDH may occur in patients with pre-existing brain atrophy and postoperative subdural effusion. Anticoagulant therapy should be avoided at the early postoperative stage after bypass surgery.