Acute contralateral subdural hygroma following craniectomy

Su, Feng-Wen; Ho, Ji-Chen; Wang, Hung-Chen

doi:10.1016/j.jocn.2006.08.019

Cited by 18 publications

(15 citation statements)

References 12 publications

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“…In that study 11 patients had SDG collections ipsilateral and 9 had hygromas contralateral to the side of the DC; 3 of the 23 SDG collections were interhemispheric. Contralateral hygromas have also been documented in case reports by Kilincer et al 34 and Su et al 66 In the present study we saw that SDGs developed in 39 (57.4%) of 68 patients who had survived > 1 month after traumatic brain injury and DC. [1][2][3] Pathogenesis and Evolution of SDG Traumatic Shearing Stress.…”

Section: Incidence Of Sdgssupporting

confidence: 80%

“…Supporting this notion are the reported cases of SDGs contralateral to the side of the DC. 66,75,76 In our series of 39 cases with SDGs, 3 hygromas were contralateral to the side of DC (Fig. 2).…”

Section: Incidence Of Sdgsmentioning

confidence: 60%

“…The SDG in this patient was evacuated first by drainage and subsequently by subdural-peritoneal shunting. Similarly, Su et al 66 have described a 63-year-old man with a posttraumatic evacuated mass who had undergone a DC and whose level of consciousness globally declined due to a contralateral SDG and significant shift of the midline structures. This patient responded well to simple drainage of the hygroma and was discharged symptom free 1 week later.…”

Section: Management and Outcomementioning

confidence: 92%

“…The incidence of an SDG following DC for severe head injury is not well documented in the literature. [1][2][3]34,66,76,77 In a 2009 study Yang et al 75 demonstrated 11 cases (6.5%) of contralateral SDGs among 169 patients who had undergone DC for severe head injury. In an earlier study 76 these same authors documented 23 cases (21.3%) of SDGs in 108 patients who had undergone DC for severe head injury.…”

Section: Incidence Of Sdgsmentioning

confidence: 99%

“…1,2,34,41,76 In this investigation, we studied the clinical and imaging characteristics of 39 patients with SDGs and compared them with those of 29 patients without to better understand the dynamics of the initial appearance, increase in volume, and resolution of this seemingly benign-looking complication following DC. [1][2][3]66,76,77 …”

mentioning

confidence: 99%

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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.