The Risk Factors of Subdural Hygroma after Decompressive Craniectomy

Abstract

ObjectiveSubdural effusion, also known as subdural hygroma (SDG), is a secondary complication that can occur after decompressive craniectomy (DC). However, the pathogenesis of SDG is not fully understood. It is unclear whether SDG occurrence is related to preoperative patient status or surgical technique. The purpose of this study is to identify risk factors for SDG after DC.MethodsFifty-nine patients who underwent DC from January 2016 to December 2016 at the same institution were analyzed. We retrospectively reviewed the clinical and radiological features of the patients. We divided the patients into two groups based on the occurrence of SDG after DC. The risk factors for SDG were analyzed.ResultsThe overall SDG rate after DC was 39% (23 patients). A statistically significant association was observed between preoperative diagnosis, e.g., subdural hemorrhage (SDH; odds ratio [OR], 4.99; 95% confidence interval [CI], 1.36–18.34) or subarachnoid hemorrhage (SAH; OR, 4.18; 95% CI, 1.07–16.32), and the occurrence of SDG after DC. Traumatic brain injury (OR, 4.91; 95% CI, 1.35–17.91) and preoperative cortical opening (OR, 4.77; 95% CI, 1.39–16.32) were important risk factors for SDG. Several surgical techniques did not show a statistically significant association with SDG. The occurrence of SDG after DC was related to the length of hospital stay (p=0.012), but not to prognosis.ConclusionAfter DC, SDG is not related to patients' prognosis but to the length of hospital stay. Therefore, it is necessary to study the occurrence of postoperative SDG by confirming the presence of preoperative SDH, SAH, and cortical opening.

Nomogram for predicting traumatic subdural effusion after mild traumatic brain injury

“…Many studies have indicated that age is not a risk factor for patients with severe TBI who have undergone decompressive craniectomy ( 6 , 7 , 11 ). However, studies have shown that older patients are prone to subdural effusion for without decompressive craniectomy ( 16 ).…”

“…Whether the formation of TSE has a greater impact on the prognosis of patients has yielded different conclusions in numerous studies. In a study by Kim et al ( 7 ), it was believed that the occurrence of TSE was unrelated to a patient's prognosis, as it only prolongs the patient's hospital stay. However, in another study ( 5 ), TSE was divided into four types according to different clinical manifestations.…”

“…Several studies investigated the risk factors for TSE; however, these studies focused only on severe TBI in patients who underwent craniectomy ( 7 , 11 , 12 ). Therefore, it remains unknown whether patients with mild TBI have identical findings; and which clinical characteristics of patients with mild TBI may lead to TSE.…”

Prediction of Shunt-Dependent Hydrocephalus after Primary Supratentorial Intracerebral Hemorrhage with a Focus on the Influence of Craniectomies

“…Shunt surgeries were performed in the patients; who showed progressively enlarged ventricles with deteriorating or failures in improvement of neurologic state; who were not tolerable to gradual reduction of amount of CSF drainage. For patients who were treated with craniectomies, the size of the craniectomy was approximated using the formula for an ellipse : AB/4, where A is the longest anterior-posterior length as determined on the axial CT cuts, and B is calculated using CT slice thickness and the number of axial cuts containing the craniotomy [ 20 ].…”

Remote Supratentorial Subdural Hematoma Following Craniectomy and Evacuation of Hypertensive Cerebellar Hematoma

“…Decompressive craniotomy or craniectomy is performed if there is no response to medical therapy in the increased intracranial pressure state. However, many complications may occur following the procedure [1,2]. Remote acute subdural hematoma (ASDH) following a decompressive craniotomy or craniectomy is a rare phenomenon [3,4].…”