Subscribe to RSS

DOI: 10.1055/s-0042-1758711
Surgical Management of the Armored Brain: Case Report of the Treatment of a Chronic Calcified Subdural Hematoma[*]
Manejo cirúrgico do cérebro blindado: Relato de caso do tratamento de hematoma subdural crônico calcificado
Abstract
Calcified chronic subdural hematomas (CCSDHs) are rare entities, whose yearly incidence ranges from 1.72 to 20.6 per every 100 thousand persons. Several different approaches to their management are reported in the literature, ranging from conservative treatment to craniotomy with full removal of the neomembranes. Currently, there are no guidelines or consensus that establish the best technique. We herein report a case of symptomatic CCSDH initially drained through a burr-hole craniotomy, with no resolution of the symptoms. Later, our patient underwent a craniotomy and partial membranectomy, which resulted in full symptomatic recovery.
Resumo
Hematomas subdurais crônicos calcificados (HSDCCs) são entidades raras, cuja incidência anual varia de 1,72 a 20,6 casos a cada 100 mil pessoas. Várias abordagens diferentes para seu manejo são relatadas na literatura, desde o tratamento conservador até a craniotomia com remoção total das neomembranas. Atualmente não há diretrizes ou consensos que estabeleçam a melhor técnica. Nós relatamos um caso de HSDCC inicialmente drenado por meio de uma craniotomia por trepanação, sem resolução dos sintomas. Posteriormente, nosso paciente foi submetido a uma craniotomia e membranectomia parcial, que resultou em plena recuperação dos sintomas.
* Study conducted at Hospital São José, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio grande do Sul, Brazil.
Publication History
Received: 01 July 2022
Accepted: 18 August 2022
Article published online:
29 November 2022
© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Sahyouni R, Goshtasbi K, Mahmoodi A, Tran DK, Chen JW. Chronic Subdural Hematoma: A Historical and Clinical Perspective. World Neurosurg 2017; 108: 948-953
- 2 Yang W, Huang J. Chronic Subdural Hematoma. 2022
- 3 Li X, Wan Y, Qian C, Yang S, Zhu X, Wang Y. Double-loculated Calcification Chronic Subdural Hematoma. Neurosurg Q 2015; 25 (02) 167-173
- 4 Rokitansky K. Handbuch der pathologischen Anatomie. Wien: Braumüller & Seidel; 1844
- 5 Dammers R, ter Laak-Poort MP, Maas AI. Neurological picture. Armoured brain: case report of a symptomatic calcified chronic subdural haematoma. J Neurol Neurosurg Psychiatry 2007; 78 (05) 542-543
- 6 Turgut M, Akhaddar A, Turgut AT. Calcified or Ossified Chronic Subdural Hematoma: A Systematic Review of 114 Cases Reported During Last Century with a Demonstrative Case Report. World Neurosurg 2020; 134: 240-263
- 7 Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg 1981; 54 (05) 637-645
- 8 Friede RL. Incidence and distribution of neomembranes of dura mater. J Neurol Neurosurg Psychiatry 1971; 34 (04) 439-446
- 9 Ludwig B, Nix W, Lanksch W. Computed tomography of the “armored brain”. Neuroradiology 1983; 25 (01) 39-43
- 10 Snopko P, Kolarovszki B, Opsenak R, Hanko M, Benco M. Chronic calcified subdural hematoma - case report of a rare diagnosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164 (02) 209-212
- 11 Trivedi A, Hiran S. Calcified epidural hematoma in pediatric age group: A report of two cases. J Neurosci Rural Pract 2010; 1 (02) 89-91
- 12 Chusid JG, De Gutiérrez-Mahoney CG. Ossifying subdural hematoma. J Neurosurg 1953; 10 (04) 430-434
- 13 Salunke P, Aggarwal A, Madhivanan K, Futane S. Armoured brain due to chronic subdural collections masking underlying hydrocephalus. Br J Neurosurg 2013; 27 (04) 524-525
- 14 Imaizumi S, Onuma T, Kameyama M, Naganuma H. Organized chronic subdural hematoma requiring craniotomy–five case reports. Neurol Med Chir (Tokyo) 2001; 41 (01) 19-24
- 15 Oda S, Shimoda M, Hoshikawa K, Shiramizu H, Matsumae M. Organized chronic subdural haematoma with a thick calcified inner membrane successfully treated by surgery: a case report. Tokai J Exp Clin Med 2010; 35 (03) 85-88
- 16 Watts C. The management of intracranial calcified subdural hematomas. Surg Neurol 1976; 6 (04) 247-250
- 17 Yang H, Tseng S, Chen Y, Lin S, Chen J. Calcified Chronic Subdural Hematoma—Case Report. Tzu-Chi Med J 2004; 16: 261-265
- 18 Petraglia AL, Moravan MJ, Jahromi BS. Armored brain: A case report and review of the literature. Surg Neurol Int 2011; 2 (01) 120-122
- 19 Callovini GM, Bolognini A, Callovini G, Gammone V. Primary enlarged craniotomy in organized chronic subdural hematomas. Neurol Med Chir (Tokyo) 2014; 54 (05) 349-356
- 20 Kaplan M, Akgün B, Seçer HI. Ossified chronic subdural hematoma with armored brain. Turk Neurosurg 2008; 18 (04) 420-424
- 21 Pappamikail L, Rato R, Novais G, Bernardo E. Chronic calcified subdural hematoma: Case report and review of the literature. Surg Neurol Int 2013; 4 (01) 21-23
- 22 Galldiks N, Dohmen C, Neveling M, Fink GR, Haupt WF. A giant bilateral calcified chronic subdural hematoma. Neurocrit Care 2010; 12 (02) 272-273
- 23 Li H, Mao X, Tao XG, Li JS, Liu BY, Wu Z. A Tortuous Process of Surgical Treatment for a Large Calcified Chronic Subdural Hematoma. World Neurosurg 2017; 108: 996.e1-996.e6
- 24 Marini A, Spennato P, Aliberti F. et al. Brain Herniation into the Subdural Space: Rare Iatrogenic Complication of Treatment of a Giant Calcified Subdural Hematoma. World Neurosurg 2020; 140: 65-70