Continuous External Drainage in the Treatment of Subdural Hematomas of Infancy

Gaskill, Sarah J.; Oakes, W. Jerry; Marlin, Arthur E.

doi:10.1159/000120580

Cited by 22 publications

(21 citation statements)

References 1 publication

(1 reference statement)

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“…2,8,16 Nevertheless, drainage must be maintained for a long period (median 6-15 days), with hospitalization in the intensive care unit and hydro-electrolytic compensation; therefore, the economic cost is high and must be taken into account along with the actual economic context. Some authors still advocate the use of minicraniotomy given its good success rate, but this method is quite invasive.…”

Section: Discussionmentioning

confidence: 99%

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury?

Blauwblomme

Rocco

Bourgeois

et al. 2015

PED

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OBJECT The ideal treatment for subdural hematomas (SDHs) in infants remains debated. The aim of this study was to analyze the safety and efficiency of subduro-subgaleal drainage in SDH. METHODS The authors conducted a single-center open-label study between August 2011 and May 2012. Data were prospectively collected in a database and retrospectively analyzed. RESULTS Eighteen patients (male/female ratio 1.25) with a median age of 5 months were surgically treated. All had preoperative symptoms of intracranial hypertension or seizures. The SDH was bilateral in 16 cases, with a median width of 12 mm. Success of the procedure was noted in 14 of the 18 patients. There was no intraoperative complication or postoperative infection. Drainage failure was attributable to suboptimal positioning of the subdural drain in 2 cases and to migration in 1 case. CONCLUSIONS Subduro-subgaleal drainage is an efficient treatment that could be proposed as an alternative to external subdural drainage or subduroperitoneal drainage.

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Section: Discussionmentioning

confidence: 99%

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury?

Blauwblomme

Rocco

Bourgeois

et al. 2015

PED

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“…While Ingram and Matson [8] had recommended craniotomy for evacuation of the hemato ma, removal of membranes, and a reduction cranioplasty to minimize the craniocerebral disproportion, the trend in recent years has been towards more conservative ap proaches such as subdural tapping [9,10], continuous external drainage [11], and subduroperitoneal shunting [12,13], The decision to perform a subduroperitoneal shunt in this patient was based on our impression that the collection of this size with multicompartmental extent was unlikely to resolve with repeated tappings. A recent study of 103 pediatric patients with subdural collections suggested that eventually 70% of the patients on whom subdural taps or continuous external drainage had been attempted end up requiring a subduroperitoneal shunt [13].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study of 103 pediatric patients with subdural collections suggested that eventually 70% of the patients on whom subdural taps or continuous external drainage had been attempted end up requiring a subduroperitoneal shunt [13]. Even in the series recommending tapping [10] or external drainage [11] as the first procedure, more than 40-50% of the patients had eventually required a shunt.…”

Section: Discussionmentioning

confidence: 99%

Intracerebral Hemorrhage after Evacuation of a Subdural Hematoma in an Infant

1994

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Intracerebral hematomas following evacuation of a subdural hematoma have been described in adults resulting from sudden decompression during the drainage of the hematoma. In infants an open fontanelle and patent sutures are expected to offer protection against sudden decompression. We report the occurrence of intracerebral hematoma in an infant following evacuation of a subdural hematoma. The multiplicity and centripetal spread of the postoperative hematomas suggested that they had resulted from sudden decompression.

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“…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.…”

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confidence: 99%

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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Continuous External Drainage in the Treatment of Subdural Hematomas of Infancy

Cited by 22 publications

References 1 publication

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury?

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury?

Intracerebral Hemorrhage after Evacuation of a Subdural Hematoma in an Infant

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

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