Multiple epidural hematomas and hemodynamic collapse caused by a subgaleal drain and suction-induced intracranial hypotension: Case report

Jonathan Roth, Eduardo Galeano, Sarah Milla, Maximilian W. Hartmannsgruber, Howard L. Weiner

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND AND IMPORTANCE: Subgaleal drains are commonly used in neurosurgery. Rare complications attributed to these drains have been described. We present a rare complication of hemodynamic collapse and multiple epidural hematomas attributed to intracranial hypotension induced by a subgaleal drain connected to suction during wound closure. CLINICAL PRESENTATION: A 3.5-year-old boy underwent an uneventful occipital lobectomy and titanium mesh cranioplasty for resection of a recurrent choroid plexus carcinoma. The child had undergone 2 uneventful previous resections and cranial irradiation. During skin closure, a subgaleal drain was connected to suction to keep the surgical bed dry. Immediately after completion of the subgaleal layer closure, there was an acute hemodynamic collapse, accompanied by bradycardia and a drop in the hematocrit. After successful resuscitation, the child underwent a brain computed tomography scan that showed a large bifrontal epidural hematoma and multiple additional small epidural hematomas. The large hematoma was surgically evacuated, and the child had an uneventful recovery. CONCLUSION: Acute negative intracranial hypotension may cause bradycardia, epidural hematomas, and hemodynamic collapse. Subgaleal drains should not be connected to suction systems, and care should be taken when these drains are connected to vacuum bulbs in high-risk cases such as after cranial irradiation, large resections, and mesh cranioplasties.

Original languageEnglish (US)
JournalNeurosurgery
Volume68
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Intracranial Hypotension
Controlled Hypotension
Suction
Hematoma
Hemodynamics
Cranial Irradiation
Bradycardia
Neurosurgery
Vacuum
Titanium
Hematocrit
Resuscitation
Tomography
Skin
Wounds and Injuries
Brain

Keywords

  • Epidural hematoma
  • Hemodynamic collapse
  • Intracranial hypotension
  • Subgaleal drain
  • Suction

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Multiple epidural hematomas and hemodynamic collapse caused by a subgaleal drain and suction-induced intracranial hypotension : Case report. / Roth, Jonathan; Galeano, Eduardo; Milla, Sarah; Hartmannsgruber, Maximilian W.; Weiner, Howard L.

In: Neurosurgery, Vol. 68, No. 1, 01.2011.

Research output: Contribution to journalArticle

Roth, Jonathan ; Galeano, Eduardo ; Milla, Sarah ; Hartmannsgruber, Maximilian W. ; Weiner, Howard L. / Multiple epidural hematomas and hemodynamic collapse caused by a subgaleal drain and suction-induced intracranial hypotension : Case report. In: Neurosurgery. 2011 ; Vol. 68, No. 1.
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