Treatment of patients with traumatic subdural effusion and concomitant hydrocephalus

Huang, Abel Po‐Hao; Tsai, Yi Hsin; Chen, Jo-Yu; Lee, Jing Er; Tu, Yong Kwang; Wang, Kuo-Chuan

doi:10.3171/2011.10.jns11711

Cited by 19 publications

(12 citation statements)

References 22 publications

(22 reference statements)

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“…Furthermore, due to the head trauma or disturbances in CSF absorption, alterations in intracranial compliance could also contribute to this complication [9,12,13,15]. I agree with the authors that most SE cases are self-limited, but in rare cases SE manifests with mass effect and ventricular dilation and even in those cases the surgical management is variable [4,16,17,23]. Accordingly, it is not clear if shunting procedures are the Bonly cure^for this type of CSF alterations in the setting of DC for TBI, as stated by the authors [7].…”

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confidence: 64%

Subdural effusion in decompressive craniectomy

Avecillas-Chasín

2015

Acta Neurochir

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Dear Editor I have read with great interest the article BAnother treatment choice for subdural effusion with ventricle dilation^by Fang et al. The authors report their experience treating subdural effusions (SE) in two patients with decompressive craniectomy (DC) using lumboperitoneal shunt [7]. Traumatic SE is an alteration of the cerebrospinal fluid (CSF) circulation that is associated with traumatic brain injury (TBI). However, SE has also been associated with DC for traumatic and non-traumatic conditions [11,18,22]. The underlying pathogenesis of SE in both conditions (DC and TBI) is different; therefore, the management of this condition could be largely different [3,10,13].Traumatic SE is a relatively common complication of TBI with a benign course in the majority of cases [23]. As the authors mentioned, the origin of TSE has been related with a tear in the subarachnoid layer probably due to the head trauma producing egress of the CSF to the subdural space in a valve-like manner [1,7,23]. Other theories have been also proposed such as the presence of a neomembrane with increased capillary permeability leading to the development of the SE [1,8]. Furthermore, due to the head trauma or disturbances in CSF absorption, alterations in intracranial compliance could also contribute to this complication [9,12,13,15]. I agree with the authors that most SE cases are self-limited, but in rare cases SE manifests with mass effect and ventricular dilation and even in those cases the surgical management is variable [4,16,17,23]. Accordingly, it is not clear if shunting procedures are the Bonly cure^for this type of CSF alterations in the setting of DC for TBI, as stated by the authors [7].On the other hand, CSF disturbances after DC could be caused by intracranial hypotension and the effect of atmospheric pressure [2, 5, 10]. After a large bone flap is removed from the cranium, atmospheric pressure is applied onto the brain parenchyma producing a significant alteration in the intracranial dynamics [2]. CSF absorption is carried out in a pressure-dependant manner through the arachnoid granulations with a directly proportional relationship between subarachnoid pressure and CSF absorption rate [14,18]. Therefore, pressurerelated alterations take place into the subarachnoid space with the subsequent alteration of the CSF absorption. This mechanism is aggravated by any communication between the subdural and subarachnoid space [10] producing the SE after DC. As the authors stated, the SE acts as compensatory mechanism of the disturbed CSF circulation due to the subarachnoid/subdural gradient. Furthermore, ventricular dilation may also occur by the same mechanism [6,18], and this event may further disturb the CSF dynamics thus increasing the subarachnoid/subdural gradient. SE is not a common finding in patients who have undergone DC for traumatic and non-traumatic conditions [1,11,21]. Therefore, other factors may play a role in the development of SE after DC.Despite that the authors report a good outcome of their patients, it is ...

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confidence: 64%

Subdural effusion in decompressive craniectomy

Avecillas-Chasín

2015

Acta Neurochir

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“…5 Although Zanini et al did not observe hygromas with mass effect and hydrocephalus, Tsuang et al did; they then proposed that hygromas with mass effect and hydrocephalus should have drainage and a ventricle shunt. 8 If identifying hydrocephalus is pivotal in managing subdural hygromas, a variety of case series has shown progressive extra-axial collections associated with craniectomy, even with treated hydrocephalus. In fact, subdural hygromas are also common after a decompressive craniectomy.…”

Section: Discussionmentioning

confidence: 99%

“…A ventricular shunt may be needed when there is a CSF circulation imbalance. 8 In this study, we describe the epidemiological features of subdural hygroma in a prospective case series.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

Arq Bras Neurocir

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Subdural hygroma is an accumulation of a cerebrospinal fluid-like fluid in the subdural space. It is a common epiphenomenon after a traumatic brain injury (TBI), but it may also occur after brain surgeries. A total of 17 patients in a prospective case series with subdural hygromas were analyzed. A male predominance (82.4%) was found. The mean age was 58.6 years. Traumatic brain injury was the main mechanism (76.5%); however, other mechanisms, such as post-craniotomy (17.6%), post-chronic subdural hematoma drainage (5.9%), and post-ventricle shunt (5.9%), were also observed. Incidental findings were diagnosed in 11.8% of the cases (mainly in elderly patients). Four patients required subdural shunt (23.5%)-all of them had TBI. Small subdural effusions were present in 35.5% of the cases. The mean time from admission to diagnosis was 6.1 days. The majority of the cases must have involved lesions of the dura-arachnoid interface since TBIs were the main causes of hygroma. The findings of incidental hygroma in elderly patients and its development after a ventricle shunt suggest that brain atrophy also plays a significant role in subdural hygroma formation. ResumoHigroma subdural é o acúmulo de fluido semelhante ao líquor no espaço subdural. É um epifenômeno comum após traumatismos crânio-encefálicos, mas também pode ocorrer após neurocirurgias. Nesta série de casos prospectiva, analisamos 17 pacientes com higroma subdural. Houve uma predominância no sexo masculino (82,4%). A idade média dos pacientes foi de 58,6 anos. Traumatismo crânio-encefálico foi o principal mecanismo (76,5%); porém outros mecanismos contribuíram para o surgimento de higroma: pós-craniotomia (17,6%), pós-drenagem de hematoma subdural crônico (5,9%), e pós-derivação ventricular (5,9%). Higromas incidentais foram diagnosticados em 11,8% dos casos (principalmente em pacientes mais velhos). Quatro pacientes necessitaram de derivação subdural (23,5%)-todos eles tiveram como mecanismo o

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“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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] .…”

Section: Introductionmentioning

confidence: 99%

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

Craig

Winston²,

Folzenlogen³

et al. 2017

Pediatr Neurosurg

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Background/Aims: The management of extracerebral collections of fluid in patients with hydrocephalus can be problematic for either their simultaneous separate management or sequential management, each of which may require multiple surgeries and the management of external drains. The object of this report is to review the experience with a shunt configuration that simultaneously diverts ventricular fluid and extracerebral fluid, whether subdural or subarachnoid in location, through different outflow resistances. Methods: The medical records, including neuroimaging of patients with hydrocephalus and clinically significant extracerebral collections of low density who were managed by implanting a differential pressure type shunt, were retrospectively reviewed. Results: Four patients, 3 children and 1 adult, met inclusion criteria. Three had the entire differential pressure shunt implanted under 1 anesthetic, and 1 had a catheter inserted into the subdural space and connected into an existing ventriculoperitoneal shunt system. The extracerebral fluid collections cleared in all 4 patients, and the CSF shunt continued to function normally. Conclusion: A single surgical procedure to implant a differential pressure shunt can simultaneously drain and obliterate an extracerebral fluid collection while managing the hydrocephalus. Compared to routines that include external drainage, differential pressure shunting requires fewer surgeries, shorter hospitalization, with expected less expense.

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Treatment of patients with traumatic subdural effusion and concomitant hydrocephalus

Cited by 19 publications

References 22 publications

Subdural effusion in decompressive craniectomy

Subdural effusion in decompressive craniectomy

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

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