Stereotactic navigation for traumatic parafalcine subdural hematoma evacuation: illustrative cases

Background: Parafalcine subdural hematomas (pSDHs) are a subtype of subdural hematoma (SDH) that occur most frequently in older patients after blunt trauma. The literature primarily describes two clinical courses for patients with pSDH: those who are neurologically intact with stable examinations and imaging and those with focal deficits, with or without hematoma progression. Surgical management is undoubtedly required for the latter group; however, there are no evidence-based guidelines specifically for pSDH. This report describes the cases of two patients with traumatic pSDH with neurological deficits who underwent surgical interventions with two different approaches and advocates for the use of stereotactic navigation to achieve adequate evacuation.

Observations: In the first case, a 55-year-old male with a parafalcine and convexity SDH underwent a hemicraniectomy, followed by a second surgery for evacuation of the residual pSDH due to a persistent neurological deficit. The second case involved an 84-year-old female with a parafalcine and convexity SDH, who underwent surgical evacuation of the pSDH with the aid of stereotactic navigation.

Lessons: Approaching the surgical evacuation of a pSDH as if it were a mass lesion led to the use of intraoperative navigation, which resulted in superior localization and complete evacuation, ultimately improving patient outcomes. https://thejns.org/doi/10.3171/CASE24541.