Subdural-peritoneal shunt: treatment for bilateral chronic subdural hematoma

Various modalities have been advocated and practiced to maximize the effectiveness of treatment for chronic subdural hematoma. Most patients with chronic subdural hematoma are successfully treated with simple burr-hole evacuation and external drainage. Hematomas with thick membranes have been found to persist or recur, sometimes necessitating reoperation or major surgery; however, they have been satisfactorily treated by repeated drainage or tapping as well. Chronic subdural hematoma can sometimes become an intractable and difficult problem. In recurring chronic collections, subdural-peritoneal shunts have been used as a mode of treatment. Treatment of recurrent subdural collection in infants has been successfully achieved by using subdural-peritoneal shunts. There is also literature to support a similar treatment for recurrent chronic subdural hematoma in older patients.

We report a case of recurrent bilateral chronic subdural hematoma in an adult, which was successfully managed by repeated burr-hole evacuation initially, followed by insertion of a subdural-peritoneal shunt. The patient did well clinically, and computerized axial tomography did not reveal any subdural collection on follow-up.

Treatment of recurrent chronic subdural hematoma is usually straightforward; however, it can sometimes be refractory to regular treatment. In managing such cases, we recommend placement of a subdural-peritoneal shunt in preference to a more complicated craniotomy and membranectomy.