title: Fibrin glue injection into the hematoma cavity for refractory chronic subdural hematoma: A case report.
abstract: BACKGROUND
  Repeat burr hole irrigation and drainage has been effective in most cases of recurrent chronic subdural hematoma (CSDH), however, refractory cases require further procedures or other interventions.
  
  
  METHODS
  An 85-year-old male presented with left CSDH, which recurred five times. The hematoma was irrigated and drained through a left frontal burr hole during the first to third surgery and through a left parietal burr hole during the fourth and fifth surgery. The hematoma had no septation and was well-evacuated during each surgery. Antiplatelet therapy for preventing ischemic heart disease was stopped after the second surgery, the hematoma cavity was irrigated with artificial cerebrospinal fluid at the third surgery, and the direction of the drainage tube was changed to reduce the postoperative subdural air collection at the fourth surgery. However, none of these interventions was effective. He was successfully treated by fibrin glue injection into the hematoma cavity after the fifth surgery.
  
  
  CONCLUSIONS
  This procedure may be effective for refractory CSDH in elderly patients.
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Saiko
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Amagasaki
authors.affiliation: Department of Neurosurgery, Tokyo University, Tokyo, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Shono
authors.affiliation: Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakaguchi
keywords: Chronic subdural hematoma; fibrin glue; recurrence; refractory