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Chronic subdural hematoma after endoscopic third ventriculostomy: case report.
Erdinç Civelek1, Tufan Cansever, Aykut Karasu
1Istanbul University, Istanbul Faculty of Medicine, Neurosurgery Department, Istanbul, Turkey. civsurgeon@yahoo.com
This case report describes a rare complication following endoscopic third ventriculostomy (ETV). A 42-year-old woman with obstructive hydrocephalus underwent ETV after initial drainage with an external ventricular drain. Four weeks later, she developed a chronic subdural hematoma, which was successfully treated with burr-hole evacuation. The patient recovered well and remained symptom-free with a patent ventriculostomy on follow-up imaging. This report adds to the limited literature on post-ETV complications and suggests that clinicians should be aware of this rare but possible outcome.
Area of Science:
- Neurosurgery outcomes research within cerebrospinal fluid dynamics
- Endoscopic neurosurgical techniques in hydrocephalus management
- Complication analysis in neurosurgical interventions
Background:
Chronic subdural hematomas are known complications in neurosurgical procedures involving the skull. Prior research has shown that ETV is generally safe for obstructive hydrocephalus. However, the occurrence of ChSDH after ETV remains poorly documented. No prior work had resolved the frequency or mechanisms of this specific complication. This gap motivated a closer examination of postoperative outcomes. The rarity of this complication makes it difficult to assess in large studies. Understanding the risk factors is essential for patient counseling. This paper contributes a detailed case report to the literature.
Purpose Of The Study:
The aim of this case report is to document a rare complication following endoscopic third ventriculostomy. The patient presented with aqueductal stenosis and obstructive hydrocephalus. The authors sought to highlight the potential for chronic subdural hematoma after ETV. This case adds to the limited literature on post-ETV complications. The procedure is typically safe, but this report emphasizes the need for awareness. The patient’s symptoms and imaging findings were carefully analyzed. The goal was to provide a clear clinical narrative. This report may help guide future diagnostic and management approaches.
Main Methods:
The patient underwent external ventricular drainage followed by ETV. Imaging was performed using CT and MRI to assess hydrocephalus. Postoperative follow-up included clinical evaluation and repeat imaging. The patient’s symptoms were monitored over time. A CT scan revealed a chronic subdural hematoma four weeks later. The hematoma was managed with burr-hole evacuation. Radiographic follow-up confirmed a patent ventriculostomy. The authors provided a detailed clinical and imaging timeline.
Main Results:
The patient developed a chronic subdural hematoma on the contralateral side after ETV. The hematoma was diagnosed four weeks post-procedure via CT imaging. Burr-hole evacuation was performed successfully. The patient’s headaches resolved after treatment. Follow-up imaging showed a patent ventriculostomy. No further complications were observed during the follow-up period. The patient remained symptom-free. This case confirms that ChSDH is a possible complication of ETV.
Conclusions:
The authors concluded that chronic subdural hematoma is a rare but possible complication of ETV. This case report adds to the limited literature on postoperative complications. The patient’s outcome was favorable after hematoma evacuation. The ventriculostomy remained patent on follow-up imaging. The authors emphasized the importance of monitoring for delayed complications. No prior work had resolved the exact mechanisms of this complication. The report suggests that clinicians should be aware of this risk. The findings may inform future diagnostic and management strategies.
Frequently Asked Questions
A chronic subdural hematoma is a collection of blood between the dura and arachnoid layers, often developing slowly after head trauma or surgery.
ETV involves creating an opening in the third ventricle to allow cerebrospinal fluid to bypass an obstruction.
Burr-hole evacuation is a minimally invasive technique to drain chronic subdural hematomas and relieve pressure on the brain.
CT and MRI scans were used to assess hydrocephalus and detect the chronic subdural hematoma.
The patient developed headaches four weeks post-ETV, leading to the diagnosis of a chronic subdural hematoma.
This case confirms that chronic subdural hematoma is a possible complication of ETV and highlights the need for awareness.
