Abstract / Summary
Abstract Background Chronic subdural hematoma (CSDH) management is particularly challenging in patients with dual abnormalities of coagulation and immune function, such as those with HIV/HCV-related liver cirrhosis and thrombocytopenia. The high risk of recurrence necessitates innovative perioperative strategies, but evidence for any specific approach is lacking. Case Presentation We report a case of a 43-year-old male with HIV/HCV-related cirrhosis, hypersplenism, and severe thrombocytopenia, who experienced multiple early recurrences of CSDH following two separate burr hole drainage procedures. After the second recurrence of a left-sided hematoma, a multidisciplinary team implemented a combined therapeutic regimen during the hypothesized early postoperative “repair window.” Intervention and Outcomes The regimen, initiated immediately after the repeated burr hole drainage, consisted of: 1) recombinant human thrombopoietin (rhTPO) 300 U/kg subcutaneously daily for 7 days; 2) oral atorvastatin 20 mg daily; and 3) adjunctive hyperbaric oxygen therapy (HBOT) at 2.0 ATA for 60 min daily for 20 sessions. Following this combined therapy, the hematoma resolved completely. The patient remained recurrence-free throughout a 12-month follow-up period. However, due to multiple confounders (prior surgeries, variable adherence, concurrent treatments), causality cannot be established. Conclusion This hypothesis-generating observation suggests that for high-risk CSDH patients with profound coagulopathy, the early postoperative period may constitute a decisive “repair window” that warrants targeted investigation. A proactive, multimodal strategy targeting hemostatic correction, membrane stabilization, and microenvironment optimization during this window may disrupt the cycle of re-bleeding, but this requires validation in future controlled studies.