[A case of huge calcified chronic subdural hematoma]

In the literature, there has been no report of spontaneously growing calcified chronic subdural hematoma (C-C-SDH). The authors report a five-year-old boy with spontaneously growing C-C-SDH. The patient was admitted to author's department on July 24, 1979, because of progressive right hemiparesis, seizure and mental as well as physical retardation. He had a birth injury caused by forceps delivery resulting in skull fracture and subarachnoid hemorrhage. Three months after birth, gradual enlargement of his head circumference was noticed. A ventriculoperitoneal shunt was performed under the diagnosis of acute hydrocephalus. At the age of 17 months, he developed meningitis followed by right hemiparesis. When he was three years old, bilateral C-SDH was found on CT. The irrigation of hematoma was not successful because of the organization of hematoma. At the age of 4, calcification of the hematoma was found on CT and plain skull x-rays. Because of deterioration of the right hemiparesis, seizure and the enlargement of C-SDH, he was admitted to author's department on July 24, 1979. The left C-SDH was totally removed on August 10, 1979 by craniotomy. The extirpated C-C-SDH was 15 X 10 cm and 2 cm in thickness. Both inner and outer capsule were thick. The organized and partially calcified tissue was found between the two capsules. Sinusoidal blood vessels were also identified on the inner and outer capsules. Postoperatively, hemiparesis became improved. The second operation to the right C-C-SDH was performed from one year later after the first craniotomy. Surgical indication of C-C-SDH has to be determined on the basis of patient's age, symptoms and length of clinical course. It has been suggested that surgical treatment of C-C-SDH in children was not successful as compared with that in adults. The authors emphasize that C-C-SDH in children should be operated to encourage mental and physical development of the patients as well as to prevent hemorrhage and growth of C-C-SDH.