Contralateral development of massive acute subdural hematoma occurrence during decompressive craniectomy and surgery for evacuation of ipsilateral acute subdural hematoma: Literature review

Contralateral massive acute subdural hematoma (ASDH) developing acutely during decompressive craniectomy for severe head injury with ASDH evacuation is very rare occurrence. Till date about seven cases are published in the western literature with outcome varying from death, vegetative existence and severe disability. Interestingly all seven cases were operated at varying time-interval following first surgery varying from 0.5 to 3 h following initial surgery. Current case is the first case in the best of knowledge of authors in western literature, who was diagnosed even got operated in continuity with good neurological outcome. Awareness of intraoperative brain swelling is important. Author presents a case occurring in a 45-year old male, developed acute subdural hematoma on contralateral side during decompressive surgery, causing sudden brain bulge, refractory to medical management, however, wound was closed rapidly and urgent CT scan carried out, revealed massive acute subdural hematoma, requiring immediate decompressive surgical intervention. In the immediate postoperative period, he required ventilatory support and discharged after two weeks following surgery. High degree of suspicion, brain bulge during surgery not relieving with routine measure warrants immediate CT scan and a rapid return to the operating room for immediate surgical intervention for acute SDH evacuation can provide good outcome.