SUBDURAL-PERITONEAL SHUNT - TREATMENT FOR BILATERAL CHRONIC SUBDURAL-HEMATOMA

BACKGROUND Various modalities have been advocated and practiced to max imize the effectiveness of treatment for chronic subdural hematoma. Mo st patients with chronic subdural hematoma are successfully treated wi th simple burr-hole evacuation and external drainage. Hematomas with t hick membranes have been found to persist or recur, sometimes necessit ating reoperation or major surgery; however, they have been satisfacto rily treated by repeated drainage or tapping as well. Chronic subdural hematoma can sometimes become an intractable and difficult problem. I n recurring chronic collections, subdural-peritoneal shunts have been used as a mode of treatment. Treatment of recurrent subdural collectio n in infants has been successfully achieved by using subdural-peritone al shunts. There is also literature to support a similar treatment for recurrent chronic subdural hematoma in older patients. CASE DESCRIPTI ON We report a case of recurrent bilateral chronic subdural hematoma i n an adult, which was successfully managed by repeated burr-hole evacu ation initially, followed by insertion of a subdural-peritoneal shunt. The patient did well clinically, and computerized axial tomography di d not reveal any subdural collection on follow-up. CONCLUSION Treatmen t of recurrent chronic subdural hematoma is usually straightforward; h owever, it can sometimes be refractory to regular treatment. In managi ng such cases, we recommend placement of a subdural-peritoneal shunt i n preference to a more complicated craniotomy and membranectomy.