RESUMO
Background: Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare and only a few cases have been reported in the literature. We report a case of CSH in the posterior fossa successfully treated with a single burr hole surgery. Case Description: A 66-year-old woman who underwent anticoagulation therapy and was suffering, in the past 3 weeks from headache, vertigo, and gait ataxia. Screening with magnetic resonance imaging demonstrated infratentorial CSH on the right cerebellar hemisphere. Coagulation was normalized and the hematoma was evacuated through a burr hole irrigation. The symptoms resolved completely within a few days. Postoperative computed tomography showed a normal postoperative appearance and resolution of hematoma. She was discharged 1 week later without any neurological deficits. Conclusion: CSH in the posterior fossa is an extremely rare condition. Due to the limited number of reports, the optimal treatment is yet unknown. In cases with coagulation disorders, less invasive and early treatment should be considered. More studies are needed to define the best management for this pathology and cases must be individualized according to each patient's particularities.
RESUMO
Introduction Cerebellopontine angle (CPA) tumors represent an important cause of persistent and refractory trigeminal neuralgia (TN). It is believed that between 1 and 9.9% of the cases of patients presenting with TN painful manifestation are caused by space-occupying lesions. Objective The objective of the present study is to describe the clinical and surgical experience of the operative management of patients presenting with secondary type TN associated with CPA tumors. Method An observational investigation was conducted with data collection from patients with secondary type TN associated with CPA tumors who were treated with surgical resection of the space-occupying lesion and decompression of the trigeminal nerve from January 2013 to November 2016 in 2 different centers in the western region of the state of São Paulo, Brazil. Results We operated on 11 consecutive cases in which TN was associated with CPA during the period of analysis. Seven (63.6%) patients were female, and 4 (36.4%) were male. Seven (63.6%) patients presented with right-side symptoms, and 4 (36.4%) presented with left-side symptoms. After 2 years of follow-up, we observed that 8 (72.7%) patients showed a complete improvement of the symptoms, with an excellent outcome, and that 3 (27.3%) patients showed an incomplete improvement, with a good outcome. No patient reported partial improvement or poor outcome after the follow-up. There was no operative mortality. Conclusion Cerebellopontine angle tumors represent an important cause of TNandmust be included in the differential diagnosis of patients presenting with refractory and persistent symptoms. Surgical treatment with total resection of the expansive lesion and effective decompression of the trigeminal nerve are essential steps to control the symptoms.
