Outcome of Surgical Treatment for Subdural Fluid Collections in Infants

Tolias, Christos M.; Sgouros, Spiros; Walsh, A. R.; Hockley, A. D.

doi:10.1159/000055952

Cited by 24 publications

(13 citation statements)

References 12 publications

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“…In our study we observed that the most important factor affecting the consciousness of patients was the mass effect of the effusion fl uid. In a study conducted by Tolias et al [13] , it was reported that the patients' clinical condition was dependent on the mass effect of the subdural effusion. In most patients included in this study, the subdural effusion was bifrontoparietally located.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment Outcomes in Subdural Effusion: A Clinical Study

Yılmaz¹,

Kıymaz²,

Yılmaz³

et al. 2005

Pediatr Neurosurg

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Objective: In this study, patients who underwent surgery due to subdural effusion were retrospectively analyzed. The location, depth and etiology of the subdural effusion, the surgical approach that was used and the recurrence rates were studied in these patients. Method: A total of 32 patients who were followed up and treated for subdural effusion at the Neurosurgery Clinic of the Yüzüncü Yıl University School of Medicine were included in the study; 18 (56%) of the patients were male and 14 (44%) were female. The surgical techniques applied were surgical burr hole drainage, repeated subdural transaxial puncture and subduroperitoneal shunt approaches. The patients were evaluated by computerized tomography of the brain in week 1 and in the third month after surgery. Recurrences were evaluated based on radiological findings and the clinical condition of the patients. Result: The consciousness level of the patients was proportional to the mass effect of the subdural effusion. Lower recurrence rates were found in patients with a large midline shift resulting from the subdural effusion. In addition, recurrence rates were higher in patients with cerebral atrophy and lower protein content in the subdural effusion fluid. It was observed that these patients responded better to the subduroperitoneal shunt treatment.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment Outcomes in Subdural Effusion: A Clinical Study

Yılmaz¹,

Kıymaz²,

Yılmaz³

et al. 2005

Pediatr Neurosurg

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“…8,13,30 In some cases, the shunt may be removed after resolution of the CSC. 8,12,13,17,25 Craniotomy for CSC is a relatively infrequent procedure and is typically reserved for cases in which the CSC is loculated. In the series reported by Caldarelli et al, 4 only 3 (4%) of 72 children underwent a craniotomy with resection of neomembranes.…”

Section: 25mentioning

confidence: 99%

“…Litofsky et al 17 found a recurrence (or "failure") rate of 78% with transfontanel taps. Tolias et al 25 had a 42% failure rate, and 25% of the patients suffered subdural empyemas.…”

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confidence: 95%

“…Each of these procedures has its own risk/benefit profile and ability to eradicate the CSC. 25 Subdural shunts have a longer-term potential morbidity. Some patients develop an unrecognized subarachnoid-to-subdural connection and become dependent on the shunt, whereas others may undergo a second surgery to remove the shunt once it has been determined that it is no longer needed.…”

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confidence: 99%

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Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants—a preliminary single-institution experience

Klimo

Matthews

Lew

et al. 2011

PED

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Object Various surgical interventions have been described to evacuate chronic subdural collections (CSCs) of infancy. These include transfontanel percutaneous aspiration, subdural drains, placement of bur hole(s) with or without a subdural drain, and shunting. Shunt placement typically provides good long-term success (resolution of the subdural fluid), but comes with well-known early and late complications. Recently, the authors have used a mini–osteoplastic craniotomy technique with the goal of definitively treating these children with a single surgery while avoiding the many issues associated with a shunt. They describe their procedure and compare it with the traditional bur hole technique. Methods In this single-institution retrospective study, the authors evaluated 26 cases involving patients who underwent treatment for CSC. Preoperative, intraoperative, and postoperative data were reviewed, including radiographic findings (density of the subdural fluid and ventricular and subarachnoid space size), neurological examination findings, and intraoperative fluid description. The primary outcome was treatment failure, defined as the patient requiring any subsequent surgical intervention after the index procedure (minicraniotomy or bur hole placement). Results Fifteen patients (10 male and 5 female; median age 5.1 months) collectively underwent 27 minicraniotomy procedures (each procedure representing a hemisphere that was treated). In the bur hole group, there were 11 patients (6 male and 5 female; median age 4.6 months) with 18 hemispheres treated. Both groups had subdural drains placed. The average follow-up for each treatment group was just over 7 months. Treatment failure occurred in 2 patients (13%) in the minicraniotomy group compared with 5 patients (45%) in the bur hole group (p = 0.09). Furthermore, the 2 patients who had treatment failure in the minicraniotomy group required 1 subsequent surgery each, whereas the 5 in the bur hole group needed a total of 9 subsequent surgeries. Eventually, 80% of the patients in the minicraniotomy group and 70% of those in the bur hole group had resolution of the subdural collections on the last imaging study. Conclusions The minicraniotomy technique may be a superior technique for the treatment of CSCs in infants compared with bur hole evacuation. The minicraniotomy provides greater visualization of the subdural space and allows more aggressive evacuation of the fluid, better irrigation of the space, the ability to fenestrate any accessible membranes safely, and continued egress of fluid into the subgaleal space. Although this preliminary report has obvious limitations, evaluation of this technique may be worthy of a prospective, multiinstitutional collaborative effort.

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“…Dear Sir, I read with interest the article entitled 'Outcome of Surgical Treatment for Subdural Fluid Collections in Infants' by Tolias et al [1]. They concluded that subdural shunting is effective, and subdural taps and burr hole drainage have a high infection risk.…”

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confidence: 99%

Subdural Fluid Collections in Infants

Erşahin¹

2001

Pediatr Neurosurg

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Outcome of Surgical Treatment for Subdural Fluid Collections in Infants

Cited by 24 publications

References 12 publications

Surgical Treatment Outcomes in Subdural Effusion: A Clinical Study

Surgical Treatment Outcomes in Subdural Effusion: A Clinical Study

Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants—a preliminary single-institution experience

Subdural Fluid Collections in Infants

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