Management of spontaneous cerebrospinal fluid hypovolemia-associated massive chronic subdural hematoma with reinforced restriction of physical activity: report of three cases

Spontaneous cerebrospinal fluid hypovolemia (SCFH) is an uncommon entity in neurosurgical practice. Without early recognition and management, some patients with SCFH can develop chronic subdural hematoma (CSDH). Generally, management of patients with SCFH without CSDH is relatively straightforward. However, this circumstance becomes more complicated in patients with concurrent CSDH. Treatment measures simply based on the respective management principles of SCFH and CSDH are insufficient or even disastrous. Our previous study showed that reinforced restriction of physical activity was a promising strategy in managing CSDH in the general population. We applied this strategy in three consecutive patients with SCFH and massive CSDH. All of the patients experienced complete resolution of CSDH. This study not only enriches the basic theory of formation and progression of CSDH, but also demonstrates that reinforced restriction of physical activity could be treated as an alternative or adjuvant management of CSDH secondary to SCFH.