Wu Zhuoxuan, Gan Yi, Wang Kun, Wang Yirong, Lv Junhui, Yang Shuxu
Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Pathology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Front Oncol. 2022 Aug 18;12:988779. doi: 10.3389/fonc.2022.988779. eCollection 2022.
Chronic subdural haematoma (CSDH) has various causes, including trauma, coagulopathies, and intracranial hypotension. However, CSDH associated with extracranial malignancy is rare. Here, we report an extremely rare case of CSDH due to prostate cancer metastasis to a haematoma capsule.
A 79-year-old man with a history of prostate cancer had a progressive decline in consciousness during hospitalization for cancer treatment. CSDH was diagnosed from computed tomography (CT) imaging. We urgently performed burr hole drainage, and the patient's symptoms improved rapidly after surgery. After removing the drainage tube, the patient's symptoms worsened again, and the repeat head CT suggested recurrence of CSDH. In a second operation, most of the haematoma capsule was excised under craniotomy, and the thickened haematoma capsule was sent for routine pathologic examination. Pathological findings confirmed the metastasis of prostate cancer to the haematoma capsule, which we believed to be related to a rapid recurrence of CSDH. After the second operation, the disease course progressed without CSDH recurrence.
For patients with malignant tumours diagnosed with CSDH, the possibility of metastasis to a haematoma capsule needs to be considered. Burr holes and drainage can easily lead to a rapid relapse. Excision of the haematoma capsule is the key to successful treatment.
慢性硬膜下血肿（CSDH）有多种病因，包括创伤、凝血功能障碍和颅内低压。然而，与颅外恶性肿瘤相关的CSDH较为罕见。在此，我们报告一例极为罕见的因前列腺癌转移至血肿包膜导致的CSDH病例。
一名79岁有前列腺癌病史的男性在因癌症治疗住院期间意识逐渐下降。通过计算机断层扫描（CT）成像诊断为CSDH。我们紧急进行了钻孔引流，术后患者症状迅速改善。拔除引流管后，患者症状再次恶化，复查头部CT提示CSDH复发。在第二次手术中，在开颅手术下切除了大部分血肿包膜，并将增厚的血肿包膜送去进行常规病理检查。病理结果证实前列腺癌转移至血肿包膜，我们认为这与CSDH的快速复发有关。第二次手术后，病程进展且未出现CSDH复发。
对于诊断为CSDH的恶性肿瘤患者，需要考虑转移至血肿包膜的可能性。钻孔引流容易导致快速复发。切除血肿包膜是成功治疗的关键。
