Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Craniofacial Surgery

Background:

• Sagittal synostosis often requires total cranial vault reconstruction when diagnosed after infancy.
• Surgical techniques for cranial vault reshaping have advanced significantly, improving safety over recent decades.

Purpose of the Study:

• To report the first published case of a chronic subdural hematoma in an asymptomatic pediatric patient after total cranial vault reshaping for sagittal synostosis.
• To investigate potential causes for the development of chronic subdural hematoma post-craniofacial surgery.

Main Methods:

• Case report of a 5-year-old patient with sagittal synostosis.
• Postoperative imaging revealed a large left-sided chronic subdural hematoma.
• Surgical intervention for the subdural hematoma was performed.

Main Results:

• The patient was asymptomatic before the discovery of the subdural hematoma on routine imaging, 4 months after initial surgery.
• The subdural hematoma was large and required surgical management.
• No immediate complications were reported following the hematoma evacuation.

Conclusions:

• Total cranial vault reshaping for sagittal synostosis, while safe, can be associated with rare complications like chronic subdural hematoma.
• A potential mechanism involves increased venous pressure due to augmented blood flow through emissary veins during surgery.
• Further research is needed to understand and mitigate the risk of subdural hematoma formation after complex craniofacial reconstructions.