Pseudotumoral Chronic Subdural Hematomas on Two Cases

摘要

Introduction: Calcified forms with pseudo-tumor symptomatology of chronic subdural hematomas are rare. They are the result of slow bleeding over several years. The main etiology is related to the complications of the ventriculo-peritoneal shunt (VP). The purpose of this study was to recall the peculiarities and physiopathology of its pseudotumoral hematomas through 2 observations. Observation: Case 1: 8-year-old patient with a history of ventriculoperitoneal shunt at 3 months of age for congenital hydrocephalus, was admitted for functional impotence of the left-side of the body of insidious onset spreading over 9 months in a chronic headache, blurred vision and generalized seizure. CT scan showed a heterogeneous subdural hematoma of the right frontoparietal with calcifications. The patient underwent an excision by morcellation of a yellowish, friable partly calcific mass. The postoperative history was marked by a total recovery of the neurological deficit. There was no recurrence at 6 months postoperatively. Case 2: 11-year-old adolescent, treated with VP shunt at 6 months of age for post-meningitic hydrocephalus, was admitted for helmet headache, dizziness, lightheadedness and apathy progressing for 3 years. CT scan showed hypodensity of right peri-hemisphere with calcified linings, exerting a mass effect on the medial structures. The patient was given a block excision of a calcific mass with blood content. The evolution was marked by the complete resolution of seizures and hemiparesis. There was no recurrence at 6 months postoperatively. Conclusion: Calcified subdural hematomas are rare and consecutive to the complications of VPS. The clinical signs are those of a benign brain tumor. Treatment is dominated by the difficulties of cerebral reexpression.