Granuloma formation as a late complication of burr-hole surgery for chronic subdural hematoma

ABSTRACT

Background

Surgical treatment remains the mainstream therapeutic regimen for chronic subdural hematoma (CSDH), and burr-hole craniostomy with subdural drainage is the preferable approach. Herein, we reported a case of intracranial granuloma formation as a late complication of burr-hole surgery for CSDH.

Case Presentation

A 31-year-old man presented with a 1-month history of headache. Head computed tomography (CT) showed a subdural hematoma in the left frontal-temporal-parietal region with significant midline shifting. A burr-hole evacuation of the hematoma with closed-system drainage was performed. CT obtained immediately after the surgery demonstrated that the hematoma was mostly evacuated. Nine months later, he presented to us again due to intermittent headache in the left temporoparietal region. Brain magnetic resonance imaging revealed a space-occupying mass at the site of the original hematoma. A bone-flap craniotomy was performed for resecting the mass. Histopathological examination revealed a granuloma. The microbial cultivation of the resected specimen was negative. The postoperative course was uneventful, and the headache was relieved.

Conclusion

Granuloma formation is an extremely rare late complication of burr-hole surgery for CSDH. Physicians involved in the perioperative management of CSDH should be aware of this condition, and bone-flap craniotomy may be warranted.

KEYWORDS:

• Granuloma
• burr-hole surgery
• chronic subdural hematoma
• complication
• neurosurgery

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

Written informed consent for publication of the case details included accompanying images was obtained from the patient. The study was approved by the research ethics committee of Peking University Third Hospital.

Consent for publication

The patient gave written consent to publish this material.

Data availability statement

To protect patient confidentiality, the data supporting this case report are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (81901202 to CY), Beijing Natural Science Foundation (7222217 to CY), and the Capital Health Research and Development of Special (2022-4-40918 to CY).