Surgical Treatment of Chronic Subdural Hygromas in Infants and Children

Abstract

Thirty-five patients (48%) were treated by means of a temporary subdural external drainage (SED) (for a total of 38 SED procedures), which was maintained for a mean of 5.8 (+/-3.4) days; it was effective in 26 cases, whereas in the other 9 it was necessary to perform a subdural-peritoneostomy (SPS). Three of these 38 SEDs were complicated by infection. In one more child the external drainage was complicated by a chronic subdural haematoma. A SPS was performed in 44 cases (61%), 9 being failed external drainages. Only in 16 (38%) of these 44 patients the SPS was removed after an average of 27.0 (+/-16.6) months. Three patients (4%) were treated by craniotomy and resection of the neomembranes lining the subdural fluid collection. Obstruction of the SPS occurred in 6 children, infection in 4. Good results were obtained with either external or internal drainage. In fact post-operative neuroradiological investigation disclosed in all the cases complete or almost complete cerebral re-expansion; also the clinical outcome was generally very good, although largely dependent upon the basic clinical condition. Unilateral subdural-peritoneal and/or external drainage was effective also in case of bilateral collections. Only 2 patients required temporary bilateral external drainage.

Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: Facts and illusions

“…The volume of the brain and the size of the ventricles could then be reduced to a minimum (Dandy, 1969). Various terms have been used to describe these conditions in literature: subarachnoid space enlargement, extra cerebral fluids collection, benign infantile hydrocephalus (Caldarelli et al, 2000), benign external hydrocephalus and the benign expansion of subarachnoid spaces (Swift and McBride, 2000). These different terms have been used arbitrarily to describe similar conditions to define the entity of EH.…”

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

“…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. Although craniotomy is the most invasive procedure, the greater exposure afforded allows the surgeon to fenestrate or resect neomembranes and gain access to compartmentalized subdural collections.…”

“…Failure rates vary widely, from 6% to 48%, with one paper reporting an infection rate of 8%. 4,7,9,16,17,27 Bur hole evacuation is slightly more invasive but is also straightforward. It requires general anesthesia and allows the surgeon to irrigate the subdural space and leave a drain in place if necessary; however, it still has the disadvantage of limited exposure and thus a relative inability to deal adequately with loculated collections.…”

The comparison between surgical procedure and conservative treatment in the management of traumatic subdural effusion

“…Poor prognosis appears when mass effect, serious brain injury or intracranial hematoma occur, and the mortality is high (1,2,4). █ InTRODuCTIOn T raumatic subdural effusion is a common disease, and has a high percentage in traumatic head injury cases (2,4,7,12,19,20). Traumatic subdural effusion occurs AIm: Traumatic subdural effusion (TSE) occurs following traumatic brain injury and may be treated by either conservative methods or surgical procedure commonly according to the patients' clinical information.…”

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ABSTRACTas the accumulation of cerebrospinal fluid (CSF) after the traumatic arachnoid rupture (2,11,20). Poor prognosis appears when mass effect, serious brain injury or intracranial hematoma occur, and the mortality is high (1,2,4).

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