Chronic Subdural Hematoma with Metastatic Involvement of the Dura and the Hematoma Outer Membrane from Esophageal Cancer: A Case Report

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Chronic subdural hematoma associated with malignant tumors rarely occurs and is frequently characterized by early recurrence and poor prognosis. Dural metastasis is the most common underlying mechanism; however, metastatic involvement of the hematoma outer membrane is extremely rare. A case of rapidly recurrent chronic subdural hematoma caused by metastatic esophageal cancer involving the dura mater and the hematoma outer membrane is reported. A 74-year-old man with stage IVB esophageal squamous cell carcinoma presented with persistent headache without a history of head trauma. Magnetic resonance imaging revealed a right-sided chronic subdural hematoma with midline shift, and burr-hole drainage was performed. However, symptoms recurred after 3 days. Contrast-enhanced magnetic resonance imaging revealed a mildly enhancing mass attached to the falx cerebri. Craniotomy revealed a dural metastatic lesion, and pathological examination confirmed poorly differentiated squamous cell carcinoma. Identical metastatic tumor cells were also found in the hematoma outer membrane. The patient recovered without new neurological deficits and subsequently underwent whole-brain irradiation. Six weeks post treatment, a cystic intracerebral lesion developed adjacent to the resection cavity and was successfully treated by cyst drainage. The patient remained free of recurrent chronic subdural hematoma and neurological deterioration until the terminal stage but ultimately died from complications associated with primary esophageal cancer 110 days after the initial surgery. Metastatic disease should be considered in patients with rapid recurrence of chronic subdural hematoma after burr-hole drainage. In such cases, craniotomy with resection of both the dural metastasis and hematoma outer membrane may be considered as a treatment option to reduce recurrence and preserve neurological function in selected patients.