Contralateral Subdural Effusion Secondary to Decompressive Craniectomy Performed in Patients with Severe Traumatic Brain Injury: Incidence, Clinical Presentations, Treatment and Outcome

Abstract

Objective: This study was performed to better understandpostoperative contralateral subdural effusion, an uncommon but serious complication secondary to decompressive craniectomy in patients with head trauma. Subjects and Methods: Data from medical records of 169 patients who underwent decompressive craniectomy after head trauma between 2003 and 2006 were collected. The data included demographics, clinical presentations, treatment and outcome. Results: Of the 169 patients, 11 (6.5%) had contralateral subdural effusion. On the average, this complication was found 14 days after decompressive craniectomy. Of the 11 patients, conservative treatment was effective in 7 with a gradual resolution which lasted 52.7 days on average. The effusion in the remaining 4 patients led to progressive deterioration of clinical presentation, and surgical intervention was necessary: subduroperitoneal shunting in 3 cases and burr hole drainage in the remaining 1 case. Conclusions: Our findings confirmed that postoperative contralateral subdural effusion was not an uncommon complication secondary to decompressive craniectomy. Most contralateral subdural effusions resolved spontaneously after conservative management, but surgical management may be necessary if the patients develop deteriorating clinical manifestations or the subdural effusion has an apparent mass effect.

Dynamics of subdural hygroma following decompressive craniectomy: a comparative study

“…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).…”

“…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.…”

“…Contralateral SDGs are more likely to induce a global decline in cognition and consciousness. Yang et al 75 have reported on 11 patients with contralateral SDGs among 169 who had undergone DC; the hygroma spontaneously resolved in 7 patients and had to be drained in 4. Kilincer et al 34 have described a 56-year-old man who had undergone a DC for malignant stroke and in whom a contralateral SDG later developed.…”

Coexistent of paradoxical herniation and subdural hygroma: a case report

“…The contralateral SDG were constantly reported, the aetiology was thought to combine with external cerebral herniation. This outward herniation combined with rapid reduction in ICP may incite a pressure gradient between the two hemispheres and lead to the enlargement of the contralateral subdural space and the accumulation of effusion, especially when, initially, there is a possible rupture in the arachnoid layer after head trauma [12][13][14]. In this case, SDG harbored in the opposite side of midline shift besides the cranial defect has never been reported before.…”

Limited Fronto-Temporo- Parietal Craniectomy in Traumatic Brain Injury: My Experience

“…2%-29%. 13,36,39,42 Subdual collection is the most common complication (50%) but it was seen in all of our patients.1,12,41 However none of them were symptomatic needing additional treatment. Seizure and congnitive dysfuntions occur due to the primary brain injury and is not related to the procedure.…”