The patient was operated by me 11-November-2013 for huge chronic subdural hematoma right cerebral convexity and check MRI done after surgery was acceptable. The patient then came to the clinic 30-November-2013 for check up with new MRI done this day with the hematoma reaccumulated. He was neurologically free, but he was complaining of fatigue and mild headache.

Using the burr holes in the right frontal and most posterior aspect of the right parietal region, craniotomy was done with reflection of the bone flap to the right ear. The dura was opened in inverted U-shaped fashion. The thick membranous hematoma was seen and dissected off the dura and evacuated. The external layer of the capsule was removed. The internal layer of the hematoma was identified and resected with strict preservation of the cortex and running arteries and veins. Strict heamostasis and water-tight closure of the dura. Routine closure of the wound with ready-vac drain under the skin.

Smooth postoperative recovery. The patient was sent to the ICU for observation.

During 35 years, most of the chronic subdural hematomas were treated successfully by the external drain. The last four cases required craniotomy after failed burr hole surgery, including this last case. This could be coincidental, but special investigations must be made to know the cause of such phenomenon.