The Clinical Course of Subdural Hygroma with Head Injury / 대한신경손상학회지

OBJECTIVE: Traumatic subdural hygroma (T-SDG) has been generally treated using conservative management rather than surgical methods. This study was performed to evaluate the clinical course of T-SDG with radiologic studies. METHODS: A retrospective study was conducted among patients diagnosed with T-SDG from January 2011 to December 2011. The patients were categorized into two groups. Group A has the widest width of T-SDG below 8 mm, Group B more than 8 mm. Computed tomography (CT) and magnetic resonance imaging (MRI) were carried out in both groups. RESULTS: Seventy-four patients were confirmed with T-SDG and were grouped as follows: 44 patients in Group A and 30 patients in Group B. There was no significant difference in age and sex ratio between group A and B. It took more time to resolve T-SDG in Group B (95.2+/-86.4 days) than Group A (14.4+/-6.7)(p<0.001). However, no significant difference was observed in the Glasgow Coma Scale (GCS) between the groups. In 10 patients of Group B, T-SDG developed into chronic subdural hematoma and one of these patients underwent surgery. CONCLUSION: Most T-SDGs were resolved after some period in this study. Surgery does not seem to be necessary in resolving T-SDG.

The Clinical Course of Subdural Hygroma with Head Injury / 대한신경손상학회지

OBJECTIVE: Traumatic subdural hygroma (T-SDG) has been generally treated using conservative management rather than surgical methods. This study was performed to evaluate the clinical course of T-SDG with radiologic studies. METHODS: A retrospective study was conducted among patients diagnosed with T-SDG from January 2011 to December 2011. The patients were categorized into two groups. Group A has the widest width of T-SDG below 8 mm, Group B more than 8 mm. Computed tomography (CT) and magnetic resonance imaging (MRI) were carried out in both groups. RESULTS: Seventy-four patients were confirmed with T-SDG and were grouped as follows: 44 patients in Group A and 30 patients in Group B. There was no significant difference in age and sex ratio between group A and B. It took more time to resolve T-SDG in Group B (95.2+/-86.4 days) than Group A (14.4+/-6.7)(p<0.001). However, no significant difference was observed in the Glasgow Coma Scale (GCS) between the groups. In 10 patients of Group B, T-SDG developed into chronic subdural hematoma and one of these patients underwent surgery. CONCLUSION: Most T-SDGs were resolved after some period in this study. Surgery does not seem to be necessary in resolving T-SDG.

Effectiveness of Early Surgery in Children with Traumatic Subdural Hygroma

OBJECTIVE: This study was performed to evaluate the usefulness of early operation in children with traumatic subdural hygroma. METHODS: The subjects were nine patients (Glasgow coma scale (GCS) score was below 10 and age was below 10 years old) who developed subdural hygroma after trauma between January 2000 to December 2002. Subduroperitoneal shunt was performed in one group and not performed in the other group. We analyzed the GCS score on admission and at 1 year after operation. Overall clinical results were evaluated retrospectively. RESULTS: Patients who underwent operation exhibited higher GCS scores at 1 year after trauma compared to those in the patients who were treated by conservative therapy(p<0.05). CONCLUSION: The early operation could be an effective treatment to children with subdural hygroma who showed delayed improvement of consciousness and to patients with hygroma that didn't decrease or was above moderate amount.

The Surgical Results of Traumatic Subdural Hygroma Treated with Subduroperitoneal Shunt

OBJECTIVE: The detection rate of traumatic subdural hygroma(TSH) has increased after the development of computed tomography and magnetic resonance imaging. The treatment method and the mechanism of development of the TSH have been investigated, but they are still uncertain. This study is performed to evaluate the effectiveness of subduroperitoneal shunt in traumatic subdural hygroma. METHODS: Five hundred thirty six patients were diagnosed as TSH from 1996 to 2002, among them, 55 patients were operated with subduroperitoneal shunt. We analyzed shunt effect on the basis of clinical indetails, including the patient's symptoms at the diagnosis, duration from diagnosis to operation, changes of GCS, hygroma types. We classified the TSH into five types (frontal, frontocoronal, coronal, parietal and cerebellar type) according to the location of the thickest portion of TSH. RESULTS: The patients who have symptoms or signs related to frontal lobe compression (irritability, confusion) or increased intracranial pressure (headache, mental change), had symptomatic recovery rate above 80%. However, the patients who have focal neurological sign (hemiparesis, seizure and rigidity), showed recovery rate below 30%. The improvement rate was very low in the case of the slowly progressing TSH for over 6weeks. We experienced complications such as enlarged ventricle, chronic subdural hematoma, subdural empyema and acute SDH. CONCLUSION: Subduroperitoneal shunt appears to be effective in traumatic subdural hygroma when the patients who have symptoms or signs related to frontal lobe compression or increased ICP and progressing within 5weeks.

Clinical Analysis of Traumatic Subdural Hygroma and its Relation with Regional Cerebral Blood Flow Using 99mTc-HMPAO SPECT

Measurement of regional cerebral blood flow with single photon emission computed tomography(SPECT) was performed using 99mTc-HMPAO in 16 patients with traumatic subdural hygroma, and we investigated the relationships between the results and the initial clinical findings and clinical outcomes on 4-month after injury. In patients with complex subdural hygroma, improvement of perfusion on follow up SPECT was correlated with the clinical outcome. But in patients with simple subdural hygroma, the clinical outcomes were good regardless of cerebral perfusion on initial SPECT and cerebral hypoperfusion was improved on follow up SPECT in all patients. These results suggested that associated parenchymal injury, initial perfusion of the frontal cortex, and improvement of perfusion on follow up SPECT were good indicators of clinical outcome. In conclusion, HMPAO-SPECT can be helpful in predicting the prognosis and assessing the effect of surgical treatment in patients with traumatic subdural hygroma.

Clinical Analysis of Chronic Subdural Hematoma Originated from Traumatic Subdural Hygroma

The authors analyzed 9 cases of chronic subdural hematoma which had been originated from traumatic subdural hygroma patients who were admitted to our department from January, 1990 to June, 1991. The results of analysis were summarized as follows: 1) The range was from 23 to 73 years of age, and fifth and sixth decade were two-thirds of all with the sex ratio of male to female 3.5 to 1. 2) The hematoma sites were all the same as those sites of previous subdural hygroma, and all site involved frontal area. 3) It took on average 8 weeks for the hygroma to convert into hematoma. 4) The major clinical symptoms and signs were headache, alteration of consciousness, motor weakness and dysphasia. 5) The densities of hematoma revealed on brain CT at the time of conversion were all hyperdense. 6) Closed drainage through burr holes resulted in an excellent clinical outcome in all cases at the time of discharge, although still remained subdural hygroma in 3 cases on follow-up brain CT. 7) Patients with traumatic subdural hygroma, even small amount, should be followed for at least 8 weeks and carefully monitored.

Role of the Measurement of Cerebral Blood Flow in the Management of Patients with Traumatic Subdural Hygroma

The finding of a traumatic subdural hygroma(SDHy) raises the question of whether to remove it surgically or not, because the management is still controversial. There has been noting but CT scan and clinical findings for neurosurgeons to decide surgical management, and most of neurosurgeons are still dependent upon their own experiences to decide the way of management for SDHy. In the present study, the authors investigated the changes of cerebral blood flow in 10 patients with SDHy by SPECT, and their relationships with the clinical findings and the results of 6-months postinjury. This study indicates that hypoperfusion of the frontal cortex, examined within a week postinjury, is a good indication for surgical management, and improvement of hypoperfusion at the follow-up SPECT, 1 month later, can predict better prognosis particularly in the cases of young age without associated brain injuries.