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

OBJECTIVE: This study was performed to better understand postoperative contralateral subdural effusion, an uncommon but serious complication secondary to decompressive craniectomy in patients with head trauma. SUBJECTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.