Usefulness of intracranial pressure measurement for chronic subdural hematoma caused by CSF leakage: A successful use of emergency epidural blood patch treatment

Abstract

  A 10％‒20％ loss of cerebrospinal fluid (CSF) due to leakage complicates some cases of chronic subdural hematoma (CSDH). It is difficult to determine the diagnosis when a CSF leak is present, and as a result a deterioration of the disease state occurs. We treated a patient with bilateral CSDH and a CSF leak in whom an imminent state was avoided by the urgent application of an epidural blood patch method. Opposite intracranial pressure is a concern in such cases, but there is no established method for addressing this. The decision whether to perform trepanation or an epidural blood patch method must be considered, but both of these treatments can worsen the patient’s condition. In the present case, we found it useful to measure the intracranial pressure to help select the treatment strategy. Through our experience, we have developed a treatment algorithm for patients with CSF leak and chronic subdural hematoma.