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01-AUGUST-2016 NAWAL ISSA MBAEDEEN 68 YEARS HUGE
EXTRADURAL HEMATOMA AFTER CRANIOTOMY FOR CHRONIC SUBDURAL HEMATOMA.
Anamnesis
The patient was operated by me
24-July-2016 for huge chronic subdural
hematoma left convexity. The dura at that time
was closed water-tightly, the bony edges were
meticulously waxed to prevent hematoma formation
and a ready vac drain with negative pressure was
inserted to the extradural space and kept for 36
hours and around 150 ml of blood came out and
was removed. The patient was doing will and
postoperative MRI was performed and it was
acceptable. The patient was discharged and came
30-July with clinical picture of hallucinations
and repeat MRI under G.A. was performed the
morning of 31-July-2016 which showed massive
extradural hematoma under the bony flap.
On examination: the patient is disoriented, but
better than before.
The bone flap was was
reflected and separated from the muscle
attachments with coagulation of all extraossal
feeders. The extradural hematoma was removed and
all the possible dural feeders were coagulated.
The bone despite presence of bone was was
bleeding, for what Vit K was given to the
patient. Small tiny incision of the dura was
created to insert the subdural part of the
external drain. The insertion was directed to
most inferior part of the subdural cavity. The
center of the bone was drilled in 2 points and
the dura was stitched to this point to prevent
future accumulation. Routine closure of the
wound.
Smooth postoperative
recovery. The patient was sent to the ICU with
the external drain with zero level to the ear
and with 50 mm H2O height to reinforce gentle
reversal of the previous conning.
Follow Up
The patient before discharge 04-August-2016,
despite all measures showed recurrence of the
extradural hematoma in the MRI. The patient is
in good condition and it was decided to evacuate
the subgalial hematoma and about 15 ml of blood
came out and to repeat this if an accumulation
recur.
Comments
The patient can be managed
conservatively, but to speed the recovering process, it was
decided to perform such procedures.
The patient dramatically improved after
surgery.
The patient seems to have hidden
hematologic problem with bleeding tendency.
The atrophied brain could explain the
shift of the dura inside, triggering subdural accumulation
of blood. It just needs time to normalize itself.
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