Romanian Neurosurgery (Dec 2023)
Cortical blindness and brain stem ischemia following burr hole evacuation of chronic subdural hematoma
Abstract
Background: Chronic SDH is commonly performed in neurosurgery. The surgery usually has good surgical outcomes. There have been few cases reports reporting cortical blindness and brain stem stroke as a dreaded complication of the same. Materials and methods: It is a retrospective, observational, descriptive type of study with analysis of patients operated for chronic SDH from March 2021 to March 2023 and reported an untoward outcome of vision loss or brainstem stroke following surgery. The cases have been reported with possible aetiology underlying the unfavourable outcome. The literature was reviewed for similar cases and a comparative analysis was done with possible hypotheses for the outcome. Observation and results: An overall 5 such cases have been reported during this period. Two cases of bilateral and three cases of unilateral chronic SDH have been reported. Out of five, two cases did not have a preceding history of trauma probably spontaneous in nature. Possibility of PRES in one case, transtentorial herniation, thrombosis, and spontaneous intracranial hypotension with kinking of vessels have been proposed. Further studies are required to address this untoward complication following evacuation of chronic subdural hematoma. Conclusions: A high index of suspicion, prompt recognition and management of reversible causes, slow decompression of hematoma especially in bilateral cases, and good hydration to prevent the possibility of thrombosis are key to preventing such complications. Also keeping the possibility in mind add on better counselling and prognostication of case in pre-surgery period.
