Subdural Fluid Accumulations Following Head Injury

Naffziger, Howard C.

doi:10.1001/jama.1924.02650480007004

Cited by 84 publications

(17 citation statements)

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“…Based on electron microscopy studies, 25,63 necropsy findings, 15,49 and the entrance of contrast material into the hygroma cavity after contrast cisternography, 46 it is hypothesized that injury to the arachnoid-dura interface layer is the central pathology in SDGs. Spillage of the CSF into the subdural space peaked at 3-4 weeks after DC, and this pathological process gradually ceased from 14-17 weeks postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of subdural hygroma following decompressive craniectomy: a comparative study

Aarabi¹,

Chesler²,

Maulucci³

et al. 2009

FOC

100

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Object This retrospective comparative cohort study was aimed at discovering the risk factors associated with subdural hygroma (SDG) following decompressive craniectomy (DC) to relieve intracranial hypertension in severe head injury. Methods Sixty-eight of 104 patients who had undergone DC during a 48-month period and survived > 30 days were eligible for this study. To assess the dynamics of subdural fluid collections, the authors compared CT scanning data from and the characteristics of 39 patients who had SDGs with the data in 29 patients who did not have hygromas. Variables significant in the appearance, evolution, and resolution of this complication were analyzed in a 36-week longitudinal study. Results The earliest imaging evidence of SDG was seen during the 1st week after DC. The SDG volume peaked between Weeks 3 and 4 post-DC and was gradually resolved by the 17th week. Among the mechanisms of injury, motor vehicle accidents were most often linked to the development of an SDG after DC (p < 0.0007), and falls were least often associated (p < 0.005). Moreover, patients with diffuse brain injury were more prone to this complication (p < 0.0299) than those with an evacuated mass (p < 0.0001). There were no statistically significant differences between patients with and without hygromas in terms of age, sex, Glasgow Coma Scale score, intraventricular and subarachnoid hemorrhage, levels of intracranial pressure and cerebral perfusion pressure, timing of decompression, and the need for CSF diversion. More than 90% of the SDGs were ipsilateral to the side of the craniectomy, and 3 (8%) of 39 SDGs showed evidence of internal bleeding at ~ 8 weeks postinjury. Surgical evacuation was needed in 4 patients with SDGs. Conclusions High dynamic accidents and patients with diffuse injury were more prone to SDGs. Close to 8% of SDGs converted themselves into subdural hematomas at ~ 2 months postinjury. Although SDGs developed in 39 (~ 60%) of 68 post-DC patients, surgical evacuation was needed in only 4.

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Section: Discussionmentioning

confidence: 99%

Dynamics of subdural hygroma following decompressive craniectomy: a comparative study

Aarabi¹,

Chesler²,

Maulucci³

et al. 2009

FOC

100

View full text Add to dashboard Cite

show abstract

“…(Nattziger, 1924;Da Costa and Adson, 1941;Miura et al 1975;French et al 1978;Fujioka et al 1981;Stone et al1981;Yoshimasu et al 1981;Wetterling et al 1988). In this study, the initial accumulation of TSH was found to develop between 1 h and 72 hs in 13 (68%) of 19 patients after the initial head injury.…”

Section: Resultsmentioning

confidence: 99%

“…Recently, the authors have diagnosed 19 patients with traumatic subdural hygroma (TSH), which was identified by serial CT. Various theories have been proposed about the mechanism contributing to the development of TSH after head injury (Nattziger, 1924;Wetterling et al 1988), but its pathogenesis still remains unclear. ( Table 2).…”

Section: Introductionmentioning

confidence: 99%

Clinical Analysis of Nineteen Patients with Traumatic Subdural Hygromas.

1994

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“…Most authors [3,4] suggest that a tear in the arachnoid allows the escape of CSF into the subdural space. The hygroma enlarges because CSF becomes trapped in the subdural space as a result of a flap-valve effect [5].…”

Section: Discussionmentioning

confidence: 99%