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Brain herniation through an internal subdural membrane: a rare complication seen with chronic subdural hematomas in

Leslie Acakpo-Satchivi1, Thomas G Luerssen

  • 1Section of Pediatric Neurosurgery, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana, USA.

Journal of Neurosurgery
|December 25, 2007
PubMed

Insights

This case study details a rare instance of brain herniation into a chronic subdural hematoma (SDH) in an infant. Successful surgical intervention led to seizure resolution and normal development.

Area of Science:

  • Pediatric Neurosurgery
  • Neurology

Background:

  • A 4-month-old infant presented with macrocrania and bilateral chronic subdural hematomas (SDH).
  • Initial treatment involved subduroperitoneal shunt placement for the chronic SDH.

Observation:

  • Eight months post-shunt placement, the patient developed new-onset seizures localized to the right frontal lobe.
  • Neuroimaging revealed focal cortical herniation through a subdural membrane into the subdural space.

Findings:

  • The patient underwent craniotomy for resection of the seizure focus and herniated cortex, with subsequent shunt replacement.
  • Two-year follow-up showed complete seizure freedom, no medication, and normal neurological and developmental status.

Implications:

  • This report describes the fourth known case of cortical herniation through a chronic subdural membrane.
  • It highlights successful surgical management and favorable outcomes in such rare pediatric neurosurgical cases.

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