title: Multiple epidural hematomas and hemodynamic collapse caused by a subgaleal drain and suction-induced intracranial hypotension: case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, New York 10016, USA. jonaroth@gmail.com
authors.forename: Jonathan
authors.initials: J
authors.lastname: Roth
authors.forename: Eduardo
authors.initials: E
authors.lastname: Galeano
authors.forename: Sarah
authors.initials: S
authors.lastname: Milla
authors.forename: Maximilian W
authors.initials: MW
authors.lastname: Hartmannsgruber
authors.forename: Howard L
authors.initials: HL
authors.lastname: Weiner
mesh_terms: D002277:Carcinoma / Q000601:surgery; D002675:Child, Preschool; D016545:Choroid Plexus Neoplasms / Q000601:surgery; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation; D006407:Hematoma, Epidural, Cranial / Q000209:etiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology* / Q000601:surgery; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation