Contralateral Subdural Effusion After Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury: Clinical Features and Outcome

Su, Tsung-Ming; Lee, Tsung‐Han; Huang, Yuhua; Su, Feng-Wen; Chen, Wu-Fu

doi:10.1097/ta.0b013e31821b092a

Cited by 16 publications

(20 citation statements)

References 12 publications

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“…1,6,14,16 Most of these collections appear in the 1st week after the DC, reach their peak volume by Week 4, and disappear by approximately Week 17. 1,9,11,12,14 Their pathogenesis is unclear. Multiple theories have been proposed to explain their occurrence and maintenance.…”

Section: Subdural Fluid Collections After DCmentioning

confidence: 99%

“…5,11,14 However, studies of the use of these approaches are limited to case reports and short case series, and the number of patients in whom a symptomatic CLSDC was managed is very small.…”

Section: Options and Rationales For Clsdc Treatmentmentioning

confidence: 99%

“…Bur hole drainage and subduroperitoneal shunting with or without cranioplasty have been suggested for those patients whose lesions do not respond to these conservative approaches. 5,[10][11][12]14 Because of the paucity of data, it remains unclear how best to manage such collections. We share our experience in managing symptomatic CLSDCs after DC.…”

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confidence: 99%

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Symptomatic contralateral subdural hygromas after decompressive craniectomy: plausible causes and management protocols

Salunke¹,

Garg²,

Kapoor³

et al. 2015

JNS

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OBJECT Contralateral subdural hygromas are occasionally observed after decompressive craniectomies (DCs). Some of these hygromas are symptomatic, and the etiology and management of these symptomatic contralateral subdural collections (CLDCs) present surgical challenges. The authors share their experience with managing symptomatic CLSDCs after a DC. METHODS During a 10-month period, 306 patients underwent a DC. Of these patients, 266 had a head injury, 25 a middle cerebral artery infarction (that is, a thrombotic stroke), and 15 an infarction due to a vasospasm (resulting from an aneurysmal subarachnoid hemorrhage [SAH]). Seventeen patients (15 with a head injury and 2 with an SAH) developed a CLSDC, and 7 of these patients showed overt symptoms of the fluid collection. These patients were treated with a trial intervention consisting of bur hole drainage followed by cranioplasty. If required, a ventriculo- or thecoperitoneal shunt was inserted at a later time. RESULTS Seven patients developed a symptomatic CLSDC after a DC, 6 of whom had a head injury and 1 had an SAH. The average length of time between the DC and CLSDC formation was 24 days. Fluid drainage via a bur hole was attempted in the first 5 patients. However, symptoms in these patients improved only temporarily. All 7 patients (including the 5 in whom the bur hole drainage had failed and 2 directly after the DC) underwent a cranioplasty, and the CLSDC resolved in all of these patients. The average time it took for the CLSDC to resolve after the cranioplasty was 34 days. Three patients developed hydrocephalus after the cranioplasty, requiring a diversion procedure, and 1 patient contracted meningitis and died. CONCLUSIONS Arachnoid tears and blockage of arachnoid villi appear to be the underlying causes of a CLSDC. The absence of sufficient fluid pressure required for CSF absorption after a DC further aggravates such fluid collections. Underlying hydrocephalus may appear as subdural collections in some patients after the DC. Bur hole drainage appears to be only a temporary measure and leads to recurrence of a CLSDC. Therefore, cranioplasty is the definitive treatment for such collections and, if performed early, may even avert CLSDC formation. A temporary ventriculostomy or an external lumbar drainage may be added to aid the cranioplasty and may be removed postoperatively. Ventriculoperitoneal or thecoperitoneal shunting may be required for patients in whom a hydrocephalus manifests after cranioplasty and underlies the CLSDC.

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Section: Subdural Fluid Collections After DCmentioning

confidence: 99%

Section: Options and Rationales For Clsdc Treatmentmentioning

confidence: 99%

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Symptomatic contralateral subdural hygromas after decompressive craniectomy: plausible causes and management protocols

Salunke¹,

Garg²,

Kapoor³

et al. 2015

JNS

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“…Clinical findings associated with DEDH include intraoperative brain swelling, 8 pupillary abnormalities, 14 increased ICP measurements, and acute neurologic deterioration. 5,15 The DEDH represents a potentially fatal complication and often requires a second surgical decompression. 10,15 A frequent radiographic abnormality found in association with a DEDH is the presence of a calvarial skull fracture, contralateral to the craniectomy (Figs 1-3).…”

mentioning

confidence: 99%

“…5,15 The DEDH represents a potentially fatal complication and often requires a second surgical decompression. 10,15 A frequent radiographic abnormality found in association with a DEDH is the presence of a calvarial skull fracture, contralateral to the craniectomy (Figs 1-3). [8][9][10][11][12][13]16 In the case series of Su et al, 8 contralateral calvarial fractures were present on the preoperative CT in 10 of 12 patients who developed a DEDH.…”

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confidence: 99%

Calvarial Fracture Patterns on CT Imaging Predict Risk of a Delayed Epidural Hematoma following Decompressive Craniectomy for Traumatic Brain Injury

Talbott

Gean

Yuh

et al. 2014

AJNR Am J Neuroradiol

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Postoperative complications influencing the long‐term outcome of head‐injured patients after decompressive craniectomy

Zhang

Liu

et al. 2018

Brain and Behavior

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ObjectivePostoperative complications are common in patients who underwent decompressive craniectomy (DC) after traumatic brain injury (TBI). However, little is known about the degree of association between the postoperative complications and the long‐term outcome of adult TBI patients after DC. The aim of this study was to evaluate the risk of postoperative complications that influenced the long‐term outcome of DC in TBI patients.MethodA total of 121 patients were studied up to 6 months after DC in TBI. The collected data included demographic, clinical and radiological information, postoperative complications, and Glasgow Outcome Scale‐Extended (GOSE) scores at follow‐up 6 months after DC. Based on their GOSE scores, they were divided into two functional groups: favorable (GOSE = 5–8) or unfavorable outcome (GOSE = 2–4) group. The characteristics of the two groups were compared using statistical analysis. Finally, a regression model was established and a receiver operating characteristic (ROC) curve was applied to analyze its performance power.ResultsOf 121 admitted patients, 31 (25.62%) sustained an unfavorable outcome. A logistic regression analysis showed that the presence of Glasgow Coma Scale (GCS) scores on admission (odds ratio [OR] 0.285, p = 0.001), posttraumatic hydrocephalus (PTH) (OR 8.688, p = 0.003), craniectomy site (OR 8.068, p = 0.033), and postoperative progressive hemorrhagic injury (PHI) (OR 6.196, p = 0.026) were independent risk factors that correlated with an unfavorable outcome. Analysis using ROC curves demonstrated that these factors had different accuracies in predicting an unfavorable outcome (AUC = 0.852 for GCS scores on admission; AUC = 0.826 for PTH, AUC = 0.617 for craniectomy site; AUC = 0.616 for postoperative PHI). The performance power of the GCS scores on admission and PTH influenced the patient's outcomes to a similar degree (p = 0.623), and either predicted the outcome better than the craniectomy site or the postoperative PHI (p < 0.05, respectively).ConclusionThese findings suggest that the occurrence of PTH and postoperative PHI were independently associated with an unfavorable long‐term outcome after DC in patients with TBI. Early prevention and treatment of PTH and postoperative PHI may be beneficial to improve the long‐term outcome, especially in patients with lower admission GCS scores or bilateral DC.

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Contralateral Subdural Effusion After Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury: Clinical Features and Outcome

Cited by 16 publications

References 12 publications

Symptomatic contralateral subdural hygromas after decompressive craniectomy: plausible causes and management protocols

Symptomatic contralateral subdural hygromas after decompressive craniectomy: plausible causes and management protocols

Calvarial Fracture Patterns on CT Imaging Predict Risk of a Delayed Epidural Hematoma following Decompressive Craniectomy for Traumatic Brain Injury

Postoperative complications influencing the long‐term outcome of head‐injured patients after decompressive craniectomy

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