Giant calcified chronic subdural hematoma adherent to the sagittal sinus: A case report and surgical considerations

Rationale: Calcified chronic subdural hematoma (CCSDH) is a rare neurosurgical condition accounting for 0.3% to 2.7% of all chronic subdural hematomas (CSDH). CCSDH typically manifests in the cerebral convexity, particularly the frontal and parietal lobes. This lesion forms primarily through gradual calcification of unabsorbed CSDH over extended periods. Patient concerns: A 33-year-old male patient, with a history of head trauma 4 years ago, subsequently developed intermittent right frontoparietal headaches, which were relieved by rest. Diagnoses: The cranial computed tomography scan revealed a mixed-density space-occupying lesion measuring approximately 9.9 cm × 5.7 cm in the right frontoparietal region. It was characterized by a thick and incomplete arc-shaped calcification layer, enclosing a hematoma in various stages of tissue or calcification. Further cranial magnetic resonance imaging examination showed that the lesion was oval-shaped, presenting as a heterogeneous low signal on T1-weighted images and a high signal on T2-weighted images. Histological examination of the excised tissue confirmed the presence of a calcified hematoma. Based on the above imaging and histological findings, a diagnosis of a giant CCSDH was established. Interventions and outcomes: The patient underwent a craniotomy to remove the lesion. The surgical procedure was smooth, with no complications occurring. Postoperative recovery was stable, and follow-up imaging confirmed near-complete resection of the lesion. During the 14-month follow-up period, the patient remained asymptomatic with no recurrence. Lessons: This case highlights the rarity and complexity of CCSDH attached to the sagittal sinus, emphasizing the importance of early recognition and surgical intervention. A literature review indicates that while surgical intervention can significantly improve the prognosis of symptomatic patients, the risks and benefits must be carefully weighed for asymptomatic cases.