Pathogenesis of spinal chronic subdural hematoma based on histopathological findings: a case report

Abstract Background Spinal chronic subdural hematoma (sCSDH) is a rare condition whereas intracranial chronic subdural hematoma (iCSDH) is well-recognised and documented in clinical settings. Despite various theories have been proposed, the exact pathogenesis of sCSDH remains to be elucidated. Herein, we report a rare case of sCSDH with co-existing iCSDH and deduce its etiology using histopathological findings. Case presentation A 76-year-old Japanese man with slight hemiparesis due to iCSDH underwent burr hole surgery with successful drainage of the hematoma. The patient could not walk unassisted after the surgery. Spinal magnetic resonance imaging (MRI) was performed, revealing a subdural hematoma extending from the T11 to S2 levels. The patient decided to undergo hematoma evacuation via a hemilaminectomy. Intraoperatively, we identified a dark liquefied hematoma with its capsule, which closely resembled an iCSDH. Histological examination of the resected capsule revealed loose fibrovascular tissues comprising capillaries, collagen fibres, small number of macrophages, and hemosiderin deposits. These findings were very similar to those for iCSDH, such that the pathogenesis of sCSDH was considered identical to that of iCSDH. The patient was transferred to a rehabilitation hospital, and 4 months after the lumbar surgery, no recurrence was observed in MRI examination. Conclusions sCSDH may result from various potential pathogeneses, that clinicians should consider for correct diagnosis and appropriate management. Our case provides valuable insights into the pathogenesis of sCSDH.