Treatment of traumatic acute subdural hematoma in adult hydrocephalus patients with cerebrospinal fluid shunt

Objective

The presence of a cerebrospinal fluid (CSF) shunt is a predisposing factor for the development of subdural hematoma (SDH) in patients with hydrocephalus. However, few reports have addressed how patients with a CSF shunt should be treated in the event of traumatic acute SDH. The purpose of this study was to show how post-traumatic management of CSF shunt affects acute SDH in adult patients with hydrocephalus.

Methods

Twelve patients were studied retrospectively. Pressure settings of shunt valve prior to head injury (HI), severity of HI, treatment on admission, changes in SDH thickness and subsequent hydrocephalus were mainly analyzed.

Results

Ten patients experienced mild HI, with nine showing neurological deterioration until admission. Five patients needed surgical hematoma removal soon after admission. SDH recurred in four cases where shunt pressure levels were kept relatively low. Shunt ligation or raising the pressure level in the programmable valve proved effective for controlling postoperative SDH in such cases. Six of the remaining seven patients underwent only shunt ligation or readjustment of pressure level in the programmable valve on admission. SDH thickness was reduced as ventricles dilated without major neurological complications. Four patients showed delayed development of SDH even though shunts were kept ligated.

Conclusions

Hematoma removal alone may result in hematoma recurrence and require a second treatment comprising shunt management to effectively control hematoma. Using shunt management as the only initial treatment can reduce hematoma volume, but some patients may suffer delayed SDH development and require surgery.