{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T18:01:25Z","timestamp":1770400885384,"version":"3.49.0"},"reference-count":18,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Retro-orbital pain occurring during burr-hole irrigation surgery for chronic subdural hematoma (CSDH) is extremely rare.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n A 65-year-old man had undergone burr-hole irrigation surgery for organized CSDH 2 months previously. The patient was referred to our hospital for thick residual hematoma and persistent motor weakness after surgery. Endoscopic removal of the hematoma and the inner membrane was performed under local anesthesia. After half of the inner membrane had been resected, the patient complained of pulsatile pain behind his left eyeball. As the removal of the inner membrane progressed, the patient became agitated reporting the pain to be excruciating. He was sedated in an attempt to resume the surgery; however, this was impossible because the brain had expanded to just beneath the dura mater. Postoperative studies revealed subarachnoid and intracerebral hemorrhages in addition to good brain expansion, while the left internal cerebral artery was dilated compared to preoperative studies. The patient recovered and was able to walk but remained disoriented.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Surgery for organized CSDH with long-term brain compression requires inner membranectomy. However, rapid decompression by aggressive membranectomy increases the risk of intracranial hemorrhage and mortality, and it is often difficult to determine how much of the membrane should be excised. In the present case, the abrupt increase in cerebral blood flow (CBF) may have resulted in hemorrhage, and this could have been avoided if the surgery had been performed in two stages. Retro-orbital pain suggests excessive CBF increase and could be a warning sign to stop surgery immediately.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_950_2025","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T07:29:36Z","timestamp":1770362976000},"page":"70","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A case presenting with retro-orbital pain during endoscopic burr-hole surgery for organized chronic subdural hematoma"],"prefix":"10.25259","volume":"17","author":[{"given":"Shoko Merrit","family":"Yamada","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Shizuoka Welfare Hospital, Shizuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryogo","family":"Ichinose","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Shizuoka Welfare Hospital, Shizuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"10.25259\/SNI_950_2025\/ref-1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.13004\/kjnt.2018.14.2.134","article-title":"Craniotomy and membranectomy for treatment of organized chronic subdural hematoma","volume":"14","author":"Baek","year":"2018","journal-title":"Korean J Neurotrauma"},{"key":"10.25259\/SNI_950_2025\/ref-2","doi-asserted-by":"crossref","first-page":"598","DOI":"10.4103\/ajns.AJNS_8_15","article-title":"Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment","volume":"12","author":"Balevi","year":"2017","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_950_2025\/ref-3","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2176\/nmc.oa2013-0099","article-title":"Primary enlarged craniotomy in organized chronic subdural hematomas","volume":"54","author":"Callovini","year":"2014","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.25259\/SNI_950_2025\/ref-4","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s101940200021","article-title":"Cluster-like headache: Literature review","volume":"3","author":"Giraud","year":"2002","journal-title":"J Headache Pain"},{"key":"10.25259\/SNI_950_2025\/ref-5","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders. 3rd edition","volume":"38","year":"2018","journal-title":"Cephalalgia"},{"key":"10.25259\/SNI_950_2025\/ref-6","doi-asserted-by":"crossref","first-page":"6328","DOI":"10.1016\/j.radcr.2024.09.062","article-title":"Middle meningeal artery embolization for organized chronic subdural hematoma combined with minimal evacuation surgery: Two case reports","volume":"19","author":"Kadono","year":"2024","journal-title":"Radiol Case Rep"},{"key":"10.25259\/SNI_950_2025\/ref-7","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S1042-3680(18)30113-X","article-title":"Regional cerebral blood flow and metabolism in chronic subdural hematoma","volume":"11","author":"Kuwabara","year":"2000","journal-title":"Neurosurg Clin N Am"},{"key":"10.25259\/SNI_950_2025\/ref-8","doi-asserted-by":"crossref","first-page":"3294","DOI":"10.12998\/wjcc.v9.i14.3294","article-title":"Cluster headache due to structural lesions: A systematic review of published cases","volume":"9","author":"Long","year":"2021","journal-title":"World J Clin Cases"},{"key":"10.25259\/SNI_950_2025\/ref-9","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/j.1468-2982.2009.01993.x","article-title":"Cluster-like headache. A comprehensive reappraisal","volume":"30","author":"Mainardi","year":"2010","journal-title":"Cephalalgia"},{"key":"10.25259\/SNI_950_2025\/ref-10","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1111\/j.1526-4610.1988.hed2809584.x","article-title":"Cluster headache: Evidence for a pathophysiologic focus in the superior pericarotid cavernous sinus plexus","volume":"28","author":"Moskowitz","year":"1988","journal-title":"Headache"},{"key":"10.25259\/SNI_950_2025\/ref-11","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/00006123-199909000-00014","article-title":"Transient hyperemia immediately after rapid decompression of chronic subdural hematoma","volume":"45","author":"Ogasawara","year":"1999","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_950_2025\/ref-12","doi-asserted-by":"crossref","first-page":"379","DOI":"10.3340\/jkns.2015.57.5.379","article-title":"Infrequent hemorrhagic complications following surgical drainage of chronic subdural hematomas","volume":"57","author":"Rusconi","year":"2015","journal-title":"J Korean Neurosurg Soc"},{"key":"10.25259\/SNI_950_2025\/ref-13","doi-asserted-by":"crossref","first-page":"e059577","DOI":"10.1136\/bmj-2020-059577","article-title":"Recent advances in the diagnosis and management of cluster headache","volume":"376","author":"Schindler","year":"2022","journal-title":"BMJ"},{"key":"10.25259\/SNI_950_2025\/ref-14","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.pjnns.2015.01.002","article-title":"Segmental cavernous carotid ectasia in a patient with cluster-like headache","volume":"49","author":"Semnic","year":"2015","journal-title":"Neurol Neurochir Pol"},{"key":"10.25259\/SNI_950_2025\/ref-15","doi-asserted-by":"crossref","first-page":"124","DOI":"10.25259\/SNI_306_2020","article-title":"Hyperperfusion and intracranial hemorrhage after burr hole surgery of chronic subdural hematoma","volume":"12","author":"Shimizu","year":"2021","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_950_2025\/ref-16","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s10143-015-0691-6","article-title":"Remote cerebellar hemorrhage after supratentorial procedures (part 1): A systematic review","volume":"39","author":"Sturiale","year":"2016","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_950_2025\/ref-17","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1055\/s-0041-1739220","article-title":"A review of remote intracerebral hemorrhage after chronic subdural hematoma evacuation","volume":"83","author":"Umana","year":"2022","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"10.25259\/SNI_950_2025\/ref-18","first-page":"e83213","article-title":"Incision of the internal membrane under an endoscope for advanced organized chronic subdural hematoma: A case report","volume":"17","author":"Yamada","year":"2025","journal-title":"Cureus"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/a-case-presenting-with-retro-orbital-pain-during-endoscopic-burr-hole-surgery-for-organized-chronic-subdural-hematoma\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/a-case-presenting-with-retro-orbital-pain-during-endoscopic-burr-hole-surgery-for-organized-chronic-subdural-hematoma\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T07:29:39Z","timestamp":1770362979000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/a-case-presenting-with-retro-orbital-pain-during-endoscopic-burr-hole-surgery-for-organized-chronic-subdural-hematoma\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":18,"alternative-id":["10.25259\/SNI_950_2025"],"URL":"https:\/\/doi.org\/10.25259\/sni_950_2025","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,6]]},"article-number":"70"}}