External hydrocephalus after aneurysm surgery: paradoxical response to ventricular shunting

Yoshimoto, Yuhei; Wakai, Susumu; Hamano, Masaaki

doi:10.3171/jns.1998.88.3.0485

Cited by 49 publications

(51 citation statements)

References 12 publications

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“…Several different terms have been utilized to describe them, including subdural hygromas, external brain tamponade or external hydrocephalus. 15,16,[22][23][24][25] None of these terms appropriately represent the physiologic changes that underlie the development of these collections.…”

Section: Discussionmentioning

confidence: 97%

“…There is no established guideline to define the minimum thickness or volume of these extra-axial collections, so we therefore defined them as fluid collections exerting mass effect, greater than 5 mm in thickness. 22 The appearance of these collections on CT scans had densities consistent with CSF, in order to exclude post-operative hematomas. Resolution of the collections was defined as the time to the first CT scan showing disappearance of the fluid.…”

Section: Methodsmentioning

confidence: 98%

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Craniectomy-Associated Progressive Extra-Axial Collections with Treated Hydrocephalus (CAPECTH): Redefining a common complication of decompressive craniectomy

Nalbach

Ropper

Dunn

et al. 2012

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 98%

Craniectomy-Associated Progressive Extra-Axial Collections with Treated Hydrocephalus (CAPECTH): Redefining a common complication of decompressive craniectomy

Nalbach

Ropper

Dunn

et al. 2012

Journal of Clinical Neuroscience

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“…PECC is not only a simple fluid accumulation in the extra-axial spaces produced after surgery but due to a fundamental pathological alteration of CSF dynamics and their pathways. Therefore the possible relationship between PECC and poor postoperative clinical outcomes needs special attention [31,32,33,34,35]. The condition is often associated with increased intracranial pressure symptoms which include severe headache and loss of consciousness.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Extra-Axial Cerebrospinal Fluid Collection – Its Pathophysiology and Clinical Management

et al. 2011

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Objective: External hydrocephalus, introduced by Dandy and Blackfan in 1914 [Am J Dis Child 1914;8:406–482], is used to describe the clinical condition of cerebrospinal fluid (CSF) accumulation in the subarachnoid space with its space expansion and increased intracranial pressure in pediatric patients. Benign subdural effusion, subdural hygroma and pseudohydrocephalus are some terms used to describe some conditions, not clearly defined at the moment as separate pathological entities. We report 3 pediatric cases which had CSF collections after craniotomy. Neuroimaging investigations revealed CSF collection after surgery. All 3 cases had a poor clinical course with resolution after shunting. This report analyzes the mechanisms and pathophysiology of postoperative extra-axial CSF collections (PECC), indicating that CSF accumulations in the extra-axial spaces (inside or outside the arachnoid) after surgery have a common pathophysiology. Therefore, the treatment protocol can be specific. Patients: Three pediatric cases, aged from 11 months to 6 years, had large tumors located from their suprasellar region to the hypothalamus and third ventricle. The tumors were excised surgically through either an anterior interhemispheric translamina-terminalis or a transsylvian translamina-terminalis approach or both. The surgery conducted created a wide opening of the anterior interhemispheric or the sylvian fissures, dissecting the lamina terminalis and Liliequist’s membrane resulting in a new artificial CSF tract from the basal cisterns to the subdural space. Clinical symptoms such as deterioration of consciousness level developed within a few weeks after surgery, and a follow-up computed tomography image confirmed subdural CSF collection. Symptoms improved after ventriculoperitoneal (V-P) shunting. Discussion: External hydrocephalus, subdural effusion and the other entities mentioned above are frequently observed in children, and little is known about their pathophysiology. To differentiate from the whole entity of CSF accumulation within the subdural and subarachnoid space, we use the term PECC to specify the main pathophysiological condition resulting from a wide dissection and opening of the arachnoid membrane and communication with the basal cisterns. Conclusion: We present the occurrence of CSF collections in the extra-axial space after surgery as the specific condition of PECC. Broadly dissecting the arachnoid membrane, with a communication remaining with the ventricles, is the main factor contributing to PECC, and patients have shown that V-P shunting is an effective procedure preventing progression and effectively treating PECC.

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“…These extra-axial collections have been referred to as subdural hygromas, 8 subdural fluid collections 9 or external hydrocephalus. 10 All of these descriptions have an implied etiological connection to hydrocephalus. Furthermore, some investigators have suggested that post-craniectomy collections should be treated with permanent cerebrospinal fluid (CSF) diversion by shunting, in the same manner that spontaneous subdural hygromas or hydrocephalus are treated.…”

Section: Introductionmentioning

confidence: 97%

Resolution of extra-axial collections after decompressive craniectomy for ischemic stroke

Ropper

Nalbach

Lin

et al. 2012

Journal of Clinical Neuroscience

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External hydrocephalus after aneurysm surgery: paradoxical response to ventricular shunting

Cited by 49 publications

References 12 publications

Craniectomy-Associated Progressive Extra-Axial Collections with Treated Hydrocephalus (CAPECTH): Redefining a common complication of decompressive craniectomy

Craniectomy-Associated Progressive Extra-Axial Collections with Treated Hydrocephalus (CAPECTH): Redefining a common complication of decompressive craniectomy

Postoperative Extra-Axial Cerebrospinal Fluid Collection – Its Pathophysiology and Clinical Management

Resolution of extra-axial collections after decompressive craniectomy for ischemic stroke

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