Subdural Effusions with Hydrocephalus after Severe Head Injury: Successful Treatment with Ventriculoperitoneal Shunt Placement: Report of 3 Adult Cases

Abstract

Background. Subdural collections of cerebrospinal fluid (CSF) with associated hydrocephalus have been described by several different and sometimes inaccurate terms. It has been proposed that a subdural effusion with hydrocephalus (SDEH) can be treated effectively with a ventriculoperitoneal shunt (V-P shunt). In this study, we present our experience treating patients with SDEH without directly treating the subdural collection. Methods. We treated three patients with subdural effusions and hydrocephalus as a result of a head injury. All the patients were treated with a V-P shunt despite the fact that there was an extra-axial CSF collection with midline shift. Results. In all of the patients, the subdural effusions subsided and the ventricular dilatation improved in the postoperative period. The final clinical outcome remains difficult to predict and depends not only on the successful CSF diversion but also on the primary and secondary brain insult. Conclusion. Subdural effusions with hydrocephalus can be safely and effectively treated with V-P shunting, without directly treating the subdural effusion which subsides along with the treatment of hydrocephalus. However, it is extremely important to make an accurate diagnosis of an SDEH and differentiate this condition from other subdural collections which require different management.

Management of subdural effusion and hydrocephalus following decompressive craniectomy for posttraumatic cerebral infarction in a patient with traumatic brain injury: a case report

“…SDEH has been described after aneurysm rupture and subarachnoid hemorrhage, [21, 22] head injuries [22] and neurosurgery, [23–25] which is a special circumstance of SDE. The mechanisms of SDEH after DC might include the tearing of some part of the arachnoid membrane, particularly the basal cisterns or lamina terminalis, allowing CSF to flow into this compartment [26]. After DC, the ICP is imbalanced in each brain cavity; the formation of SDE requires less pressure than the enlargement of ventricles [24].…”

6 postoperative imaging of TBIPostoperative Imaging of Traumatic Brain Injury

“…15 Another potential complication that can occur days to weeks after surgery for TBI is the development of excess extraventricu lar CSF, sometimes referred to as external hydrocephalus. 16 Ex ternal hydrocephalus is more commonly discussed in pediatric imaging l courses spp. (a) Noncontrast head computed tomography (CT) at initial assessment shows a right temporal acute subdural hematoma (aSDH) as well as a frontal lobe contusion (inset image).…”

“…16 Growing contusion after subdural hematoma (SDH) evacuation. (a) Initial com puted tomography (CT) shows a holohemispheric right aSDH and right frontal hemorrhagic con tusion.…”

Differential Pressure Shunt for Simultaneous Diversion of Ventricular Fluid and Extracerebral Fluid

“…Shunting of extracerebral fluid into the peritoneal space is an effective surgical alternative and requires shorter hospitalization and probably fewer interventions than for external drainage [1,2] , but most neurosurgeons eventually electively remove the shunt. There have been case reports of resolution of subdural fluid collections following ventriculoperitoneal shunt alone [1] but most patients with ventriculomegaly treated with subdural shunt and without ventricular drainage subsequently require ventriculoperitoneal shunts [2,3] .…”

“…There have been case reports of resolution of subdural fluid collections following ventriculoperitoneal shunt alone [1] but most patients with ventriculomegaly treated with subdural shunt and without ventricular drainage subsequently require ventriculoperitoneal shunts [2,3] . Fang et al [4] , arguing that subdural shunting alone is insufficient to treat traumatic subdural effusions in the presence of ventricular dilation, reported successful resolution with lumbarperitoneal shunting.…”