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March 9, 1979

New surgical treatment for chronic subdural hematoma

JAMA. 1979;241(10):983-987. doi:10.1001/jama.1979.03290360007005

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A new surgical approach to subdural hematoma in children shows promise for reducing chronic collections of fluid in subdural spaces.

By lowering and advancing the superior sagittal sinus (a venous sinus of the dura mater) with the overlying sagittal suture and then performing a duraplasty, neurosurgeon Francisco Gutierrez, MD, and colleagues at Children's Hospital of Chicago eliminate narrowing and angulation of the cortical veins, which they believe to be a cause of the continual fluid accumulation.

"We postulate that one possible mechanism in this condition is the stretching and narrowing of the cortical veins that bridge the subarachnoid and subdural spaces to enter the superior sagittal sinus," says Gutierrez. "The accumulation of fluid is the initial cause of the 'hanging veins' and may lead to their thrombosis and narrowing. Then, elevated back pressure favoring the formation of a transudate often follows, and the veins are unable to resume their normal