title: Subdural-peritoneal shunt: treatment for bilateral chronic subdural hematoma.
abstract: BACKGROUND
  Various modalities have been advocated and practiced to maximize the effectiveness of treatment for chronic subdural hematoma. Most patients with chronic subdural hematoma are successfully treated with simple burr-hole evacuation and external drainage. Hematomas with thick membranes have been found to persist or recur, sometimes necessitating reoperation or major surgery; however, they have been satisfactorily treated by repeated drainage or tapping as well. Chronic subdural hematoma can sometimes become an intractable and difficult problem. In recurring chronic collections, subdural-peritoneal shunts have been used as a mode of treatment. Treatment of recurrent subdural collection in infants has been successfully achieved by using subdural-peritoneal shunts. There is also literature to support a similar treatment for recurrent chronic subdural hematoma in older patients.
  
  
  METHODS
  We report a case of recurrent bilateral chronic subdural hematoma in an adult, which was successfully managed by repeated burr-hole evacuation initially, followed by insertion of a subdural-peritoneal shunt. The patient did well clinically, and computerized axial tomography did not reveal any subdural collection on follow-up.
  
  
  CONCLUSIONS
  Treatment of recurrent chronic subdural hematoma is usually straightforward; however, it can sometimes be refractory to regular treatment. In managing such cases, we recommend placement of a subdural-peritoneal shunt in preference to a more complicated craniotomy and membranectomy.
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago 60612, USA.
authors.forename: M
authors.initials: M
authors.lastname: Misra
authors.forename: J L
authors.initials: JL
authors.lastname: Salazar
authors.forename: D M
authors.initials: DM
authors.lastname: Bloom
mesh_terms: D000368:Aged; D001921:Brain / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D006408:Hematoma, Subdural / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D010536:Peritoneovenous Shunt; D012008:Recurrence; D014057:Tomography, X-Ray Computed