Contralateral subdural effusion secondary to decompressive craniectomy performed in patients with severe traumatic brain injury: incidence, clinical presentations, treatment and outcome

This study was performed to better understandpostoperative contralateral subdural effusion, an uncommon but serious complication secondary to decompressive craniectomy in patients with head trauma. 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. 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. 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

Traumatic subdural hygroma: five cases with changed density and spontaneous resolution

Thirty-four consecutive adult patients with subdural traumatic hygroma were analysed for clinical evolution, serial computed tomography scan (CT), and magnetic resonance imaging (MRI) over a period of several months. Five of the patients presented CT scan and MRI evolution data showing increasing density over a period of 11 days to 6 months post trauma. In these five patients, final clinical and CT scan data were benign, with complete spontaneous resolution. Descriptions in literature of evolving traumatic subdural hygroma have presented CT scan density modifications changing into chronic subdural hematoma. Our patients show another possibility, density transformation, which sometimes show as subdural hematoma in CT scan and MRI, but with final evolution where clinical condition and CT scan return to normal.

Analisamos 34 pacientes adultos com higroma subdural traumático quanto à evolução clínica, tomografias seriadas e ressonância magnética. Observou-se aumento da densidade do higroma subdural em cinco dos pacientes durante período que variou de 11 dias a 6 meses após o trauma. Nestes cinco pacientes, a evolução clínica foi favorável e os higromas apresentaram resolução espontânea. Há vários relatos na literatura de modificação da densidade dos higromas subdurais tramáticos, transformando-se em hematoma subdural crônico. Esta casuística apresenta outra possibilidade, ou seja, modificação da densidade, que pode ser apresentada como hematoma subdural pelas imagens de tomografia ou ressonância magnética, mas com resultado final das condições clínicas e de imagem retornando ao normal.

Les epanchements sous-duraux idiopathiques du nourrisson

L'article porte sur le diagnostic sous-dural idiopathique chez 6 nourrissons dans un centre de 1990 a 1995 apres exclusion de toute cause connue. L'analyse d'elements cliniques et paracliniques a permis de faire les constatations suivantes: les antecedents d'epanchement sous-dural ont ete retrouves dans la fratrie; le perimetre cranien n'a pas excede les valeurs moyennes pour l'age et le sexe; l'echographie transfontanellaire a ete l'examen le plus precis; Ces collections liquidiennes souvent bilaterales etaient susceptibles de se reconstituer meme apres un traitement chirurgical et enfin; un retard psycho-moteur a ete releve au cours de l'evolution chez un enfant. La survenue possible des complications et sequelles peut faire reconsiderer le caractere benin de cette pathologie