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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
DOI: 10.1055/s-0043-1774750
Case Report

Surgical Treatment of Chronic Subdural Hematoma under Local Anesthesia: Case Report and Literature Review

Tratamento Cirúrgico de Hematoma Subdural Crônico sob Anestesia Local: Relato de Caso e Revisão de Literatura
Carlos Umberto Pereira 
1   Department of Neurosurgery, Emergency Hospital (HUSE), Aracaju, Sergipe, Brazil.
,
Débora Moura da Paixão Oliveira 
2   Brazilian Nursing Association in Neurology and Neurosurgery, Aracaju, Sergipe, Brazil.
,
Lauro Roberto de Azevedo Setton 
3   Tiradentes University, Aracaju, Sergipe, Brazil.
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Abstract

Introduction Optimal surgical treatment for chronic subdural hematoma (CSDH) in the elderly has been controversial. Whenever possible, a less invasive technique should be used to avoid complications.

Case Report The patient was 82-years-old, with JPS; with diagnosis of liver cirrhosis due to alcohol abuse and history of recent myocardial infarction. He was admitted to the emergency room with temporal-spatial disorientation. The Glasgow coma scale (GCS) value on admission was 9. Left hemiparesis and osteotendinous hyperreflexia in the left side of the body. Noncontrast-enhanced cranial computed tomography (CT) showed right frontoparietal hypodense lesion with mass effect. Due to the clinical conditions of the patient, drainage of the hematoma was indicated through local anesthesia and sedation with midazolam. He was discharged after 8 days with improvement in his mental and neurological condition.

Conclusion Drainage of CSDH using local anesthesia in an elderly person with severe comorbidity can reach excellent results.

Resumo

Introdução O tratamento cirúrgico ideal para hematoma subdural crônico (HSDC) em idosos tem sido controverso. Sempre que possível uma técnica menos invasiva deve ser utilizada para evitar complicações.

Relato do Caso Paciente de 82 anos portadora de JPS; com diagnóstico de cirrose hepática por abuso de álcool e história de infarto do miocárdio recente. Foi admitido no pronto-socorro com desorientação espaço-temporal. O valor da escala de coma de Glasgow (ECG) na admissão era 9. Hemiparesia esquerda e hiperreflexia osteotendinosa no lado esquerdo do corpo. A tomografia computadorizada (TC) de crânio sem contraste mostrou lesão frontoparietal hipodensa direita com efeito de massa. Devido às condições clínicas do paciente foi indicada drenagem do hematoma através de anestesia local e sedação com midazolam. Teve alta após 8 dias com melhora do quadro mental e neurológico.

Conclusão A drenagem do HDC com anestesia local em idoso com comorbidade grave pode alcançar excelentes resultados.

Keywords

chronic subdural hematoma - general anesthesia - local anesthesia - treatment

Palavras-chave

hematoma subdural crônico - anestesia geral - anestesia local - tratamento


Publication History

Received: 14 April 2023

Accepted: 05 July 2023

Article published online:
18 October 2023

© 2023. 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/)

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