Postoperative Remote Acute Subarachnoid Hemorrhage as a Complication of Chronic Subdural Hematoma Evacuation With Burrhole: A Case Report and Literature Review

Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Surgical evacuation, particularly burr hole trephination, is the preferred treatment method. However, postoperative complications such as hematoma recurrence and intracerebral hemorrhage may occur. Isolated subarachnoid hemorrhage (SAH) is rare but can occur after the evacuation of a CSDH. We presented the case of an 83-year-old male who underwent the double burr hole evacuation of the left CSDH and then had SAH in the immediate postoperative CT scan. The vascular study was negative, and the patient was treated medically for SAH, resulting in a full recovery. We also found four similar reports in the literature. This is a rare complication; no vascular lesions have been identified in recorded cases. Most cases recover completely, with one fatality reported. It's generally considered a benign condition. Our recommendations include strict perioperative blood pressure management, preventing rapid or excessive drainage, and reversing anticoagulants to avoid this complication.