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Granuloma formation as a late complication of burr-hole surgery for chronic subdural hematoma
Chenlong Yang1, Guozhong Lin1, Jia Zhang
1Department of Neurosurgery, Peking University Third Hospital, Beijing, China.
Insights
Intracranial granuloma formation is a rare complication following burr-hole surgery for chronic subdural hematoma (CSDH). This case highlights the importance of considering granuloma in patients with persistent headaches after CSDH treatment.
Area of Science:
- Neurosurgery
- Neuropathology
Background:
- Chronic subdural hematoma (CSH) is typically managed with burr-hole craniostomy and subdural drainage.
- This surgical approach is considered the standard of care for CSH.
Observation:
- A 31-year-old man underwent burr-hole evacuation for a symptomatic CSH.
- Nine months post-surgery, the patient developed recurrent headaches and a space-occupying mass was identified at the original hematoma site.
- Histopathological examination confirmed the mass to be a granuloma, with negative microbial cultures.
Findings:
- Intracranial granuloma formation is an exceptionally rare late complication of burr-hole surgery for CSH.
- The granuloma presented as a space-occupying lesion causing recurrent symptoms.
Implications:
- Neurosurgeons and physicians managing CSH should be aware of granuloma formation as a potential late complication.
- Bone-flap craniotomy may be necessary for the resection of such granulomas.
Background:
Surgical treatment remains the mainstream therapeutic regimen for chronic subdural hematoma (CSDH), and burr-hole craniostomy with subdural drainage is the preferable approach. Herein, we reported a case of intracranial granuloma formation as a late complication of burr-hole surgery for CSDH.
Case Presentation:
A 31-year-old man presented with a 1-month history of headache. Head computed tomography (CT) showed a subdural hematoma in the left frontal-temporal-parietal region with significant midline shifting. A burr-hole evacuation of the hematoma with closed-system drainage was performed. CT obtained immediately after the surgery demonstrated that the hematoma was mostly evacuated. Nine months later, he presented to us again due to intermittent headache in the left temporoparietal region. Brain magnetic resonance imaging revealed a space-occupying mass at the site of the original hematoma. A bone-flap craniotomy was performed for resecting the mass. Histopathological examination revealed a granuloma. The microbial cultivation of the resected specimen was negative. The postoperative course was uneventful, and the headache was relieved.
Conclusion:
Granuloma formation is an extremely rare late complication of burr-hole surgery for CSDH. Physicians involved in the perioperative management of CSDH should be aware of this condition, and bone-flap craniotomy may be warranted.
