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PubMed2004

Further characterization of traumatic subdural collections of infancy. Report of five cases.

Bilateral convexity and interhemispheric subdural hematomas are common neuroimaging patterns seen in infants who have sustained nonaccidental head injuries (NAHIs). These collections often appear aschronic or acute-on-chronic on computerized tomography (CT) studies. To determine the nature of these extraaxial fluid collections and their relationship to cerebrospinal fluid (CSF) dynamics, the authors studied five infants with suspected NAHI in whom symptomatic bilateral mixed- or low-density subdural collections were revealed on imaging studies; the patients underwent burr hole evacuation of the hematoma and external drainage. Once decompression was achieved, radiotracer was injected into the lumbar subarachnoid space, and the subdural drainage system was monitored for appearance of the isotope. In all five cases, the radiotracer moved rapidly from the lumbar subarachnoid space into the convexity subdural space and then into the external drainage system. This indicated the possibility that some of these mixed-density subdural collections were acute blood mixed with CSF rather than acute-on-chronic collections arising from rebleeding subdural membranes. The authors propose that, during infancy, tears in the loosely adherent arachnoid envelope at the main arachnoid granulation site along the superior sagittal sinus may result in a considerable amount of CSF mixing with acute blood in the subdural space, creating a hematohygroma.

Brain Injuries↗
PubMed2000

Iatrogenic acute subdural hematoma due to drainage catheter.

BACKGROUND: Insertion of a catheter for drainage of a cavity is a routine step in many surgical practices. In neurosurgery, catheters are commonly placed in the subdural, subgaleal, or epidural spaces to prevent haematoma formation. CASE DESCRIPTION: We present three cases of iatrogenic acute subdural hematoma. These were all related to the drainage catheters. In the first case, a subgaleal redivac suction catheter was used after craniotomy for brain abscess. The other two patients had ordinary ventricular catheters placed in the subdural space after burr hole drainage of chronic subdural hematoma. The drainage catheter was removed on postoperative day 5 in the first case and two days after the initial operation in the other two cases. Shortly after the removal of the drains, the conditions of the patients deteriorated rapidly due to the development of acute subdural hematoma. CONCLUSION: Although they are extremely uncommon, life-threatening complications related to a drainage catheter are a real possibility. Therefore, the procedure should not be taken lightly.

Acute Disease↗
PubMed1987

Pericerebral collections after shunting.

Nineteen pericerebral collections (18 subdural and 1 epidural) occurred in a series of 682 consecutive initial shunt insertions for hydrocephalus in children, performed between 1976 and 1984. No collections were observed in 358 reoperations performed in the same patients during the same period. The incidence rate of this complication is nearly four times higher after 2 years of age than in younger children (6.5% versus 1.7%). The rate is also higher, regardless of age, in noncommunicating than in communicating hydrocephalus. Pericerebral collections are observed with high- as well as low-closing pressure valves. Pericerebral collections after shunting were diagnosed in 80% of the cases less than 2 months after surgery. They were asymptomatic in nearly 60% of the cases but could become symptomatic later when they were not treated. At the onset at least, these pericerebral collections are compensated by the outflow of an equal quantity of intraventricular CSF so that ICP is only moderately elevated. Postshunt pericerebral collections may be the consequence of CSF loss at the time of surgery. In most cases, however, they are due to a CSF overdrainage by the valve. This overdrainage, together with the reversal of CSF flow in the highly resistant CSF pathways of hydrocephalus, establishes a pressure lower in the ventricles than in the subarachnoid space and tends to open up the subdural space. The treatment of postshunt subdural collections is the insertion of a simple tubing without valve between the subdural space and the peritoneum, the ventriculoperitoneal shunt being left in place. With this treatment, more than 80% of the collections disappeared or were improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗