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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1810102
Case Report

Simultaneous Burr Hole Drainage and Epidural Blood Patch with Real-Time ICP Monitoring for Subdural Hematoma Associated with Spontaneous Intracranial Hypotension: Case Report and Technical Note

Yuki Sunohara 
1   Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya City, Aichi Prefecture, Japan
2   Department of Neurosurgery, Japan Community Healthcare Organization Chukyo Hospital. Nagoya City, Aichi Prefecture, Japan
,
Yoshitaka Nagashima
1   Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya City, Aichi Prefecture, Japan
,
Yusuke Nishimura
1   Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya City, Aichi Prefecture, Japan
,
Jungsu Choo
2   Department of Neurosurgery, Japan Community Healthcare Organization Chukyo Hospital. Nagoya City, Aichi Prefecture, Japan
,
Fumihiro Sago
2   Department of Neurosurgery, Japan Community Healthcare Organization Chukyo Hospital. Nagoya City, Aichi Prefecture, Japan
,
Daiki Somiya
2   Department of Neurosurgery, Japan Community Healthcare Organization Chukyo Hospital. Nagoya City, Aichi Prefecture, Japan
,
Kenko Maeda
2   Department of Neurosurgery, Japan Community Healthcare Organization Chukyo Hospital. Nagoya City, Aichi Prefecture, Japan
,
Akira Ikeda
2   Department of Neurosurgery, Japan Community Healthcare Organization Chukyo Hospital. Nagoya City, Aichi Prefecture, Japan
,
Ryuta Saito
1   Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya City, Aichi Prefecture, Japan
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Abstract

Spontaneous intracranial hypotension (SIH) is a condition caused by cerebrospinal fluid (CSF) leakage, leading to low intracranial pressure (ICP), brain sagging, and subdural hematoma (SDH). Management of SIH complicated by SDH presents a clinical challenge: treating CSF leaks is performed by epidural blood patch (EBP), which elevates ICP, while SDH management typically requires hematoma evacuation, producing a reductive effect on ICP. Mismanagement can result in severe complications such as brain herniation or rebound intracranial hypertension. We report two cases of SIH-associated SDH successfully treated with simultaneous burr hole drainage and EBP, guided by continuous ICP monitoring. Both patients presented with significant SDHs and clinical signs of SIH. At the start of the procedure, subdural ICP was relatively low. After administration of autologous blood, ICP rose rapidly to over 30 mm Hg, reaching levels considered dangerously high if left unaddressed. The hematoma was evacuated without delay, and patients had no recurrence or complications. EBP under real-time monitoring facilitated timely intraoperative decisions and tailored responses to dynamic intracranial changes. This approach provides a framework for individualized and safe intervention in complex dual-pathology scenarios.

Keywords

cerebrospinal fluid leak - epidural blood patch - intracranial pressure monitoring - spontaneous intracranial hypotension - subdural hematoma

Authors' Contributions

All authors contributed to the conception and design of the study and reviewed and approved the final manuscript for submission and publication. K.M., A.I., Y.S., F.S., D.S., and J.C. were responsible for conceptualization. Methodology was led by Y.S. and J.C. The original draft was prepared by Y.S., with both Y.S. and Y.N. involved in reviewing and editing. Supervision was managed by Y.N. and R.S.


Ethical Approval

This study was performed by the ethics committee guidelines and principles of the Declaration of Helsinki.


Patients' Consent

Written informed consent to publish this information was obtained from study participants.




Publikationsverlauf

Artikel online veröffentlicht:
25. Juli 2025

© 2025. Asian Congress of Neurological Surgeons. 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/)

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