Spontaneous chronic spinal subdural hematomas in pediatric patients: illustrative cases

Background: Spontaneous chronic spinal subdural hematomas (cSSDHs) are a rarely reported clinical pathology in pediatric patients in which subdural blood accumulates without an obvious etiology.

Observations: The authors report 2 cases of pediatric patients with cSSDHs with no known nonaccidental trauma, coagulopathy, or underlying vascular malformation. The patients presented with progressive back pain and paresthesias. Both cases were treated successfully with decompression and evacuation of subdural blood products using a posterior short-segment laminectomy (case 1) or laminoplasty (case 2), which yielded satisfactory improvement in pain and no recurrence through follow-up.

Lessons: Chronic SSDHs are not always associated with an underlying vascular malformation or coagulopathy. Posterior decompression and evacuation of blood products can yield satisfactory outcomes without early recurrence. Spontaneous spinal subdural hematoma should be a diagnosis of exclusion after thorough workup to rule out potentially underlying etiologies of the pathology. https://thejns.org/doi/10.3171/CASE26105.