Recurrent chronic subdural hematoma with trabeculae converging toward a burr hole

Radiographically, trabeculae have been observed commonly in chronic subdural hematoma (CSDH) patients. Nevertheless, few authors have focused on how the trabeculae develop. We, herein, report a case of recurrent CSDH in which the evolution of trabeculae was observed with serial brain computed tomography.

A 75-year-old man with symptomatic left-sided CSDH who had undergone a burr-hole craniostomy 14 days in our institution earlier came back with a recurrent CSDH with trabeculae within the hematoma cavity. The trabeculae, which had not been present in the first surgery, developed relatively rapidly, converging toward the burr hole. The recurrent CSDH was successfully treated with the middle meningeal artery embolization. During the procedure, a vascular brush was observed around the burr hole, indicating the trabeculae were rich in blood flow.

Surgical manipulation of the outer membrane during the first surgery might likely have elicited local inflammation and subsequent neovasculization of the outer membrane, resulting in trabeculae formation around the burr hole.