Long-term external drainage for subdural collections in infants

The treatment of subdural collections in infants remains controversial. In order to evaluate the treatment guidelines that we developed on the basis of our earlier experience, we have reviewed the results obtained in 31 consecutive infants with symptomatic chronic and subacute subdural collections treated with external drainage. Using our guidelines for removal of the drains, there was only a very low rate of permanent shunting (4/31), with a low complication rate and good clinical results. However, the long period of external drainage, and therefore of hospitalization, might make if general application of these guidelines problematic. Received: 15 November 1999 Revised: 16 February 2000     

显微硬膜下腔-侧裂池沟通术治疗潜在难治性硬膜下腔积液

目的探讨潜在难治性硬膜下腔积液显微外科一次性微创治疗的可行性和优越性。方法对9例有影像学占位效应的硬膜下腔积液且合并脑萎缩患者,采用一次性经颅锁孔显微硬膜下腔—侧裂池沟通术。结果术后硬膜下积液完全消失和大部消失8例,部分消失1例。相关的临床症状消失,无复发。结论采用一次性经颅锁孔显微硬膜下腔—侧裂池沟通术治疗难治性硬膜下腔积液,可达到根本的病因治疗、有效的积液吸收和满意的组织复位。     

慢性硬膜下血肿钻孔引流术后硬膜下脓肿形成的治疗

目的慢性硬膜下血肿术后并发硬膜下脓肿极为罕见,治疗方式多为再次置管引流,而选择开颅治疗极少,本文将对其开颅治疗进行讨论。方法回顾报道开颅手术治疗的两例慢性硬膜下血肿钻孔引流术后并发硬膜下脓肿的病例。结果两例病人预后均较好,未残留明显的神经系统受损体征。结论硬膜下脓肿术前的影像学评估十分重要,手术方式是选择再次钻孔引流还是开颅手术需依据术前影像学特征来合理选择,静脉应用敏感抗生素一定要足量、全程。     

Coiling and migration of peritoneal catheter into the breast: a very rare complication of ventriculoperitoneal shunt

Upward migration of distal catheter of a ventriculoperitoneal shunt with coiling is very rare. Pseudocyst and galactorrhea are known breast-related complications. Here, we report a 13-year-old girl, known case of myelomeningocele and shunted hydrocephalus, who presented with right breast pseudocyst due to distal tube migration and coiling of the catheter. Plain radiography was not diagnostic because of severe levoscoliosis, but chest computed tomography scan was confirmatory of shunt coiling lateral to the breast. The possible mechanisms causing this uncommon complication are described.     

A method for continuous external drainage in the management of infantile subdural collections

There is no consensus on the management of infantile chronic subdural collections. Subdural tapping, craniotomy and removal of membranes, and shunting from the subdural space have all been used. We performed continuous external subdural drainage (CESD) as a step prior to subdural-peritoneal shunt placement in the management of infantile chronic subdural fluid collections. A lumbar drainage set was used for CESD. The catheter was placed in the subdural space through the anterior fontanel with a Touhy needle. This percutaneous technique seems an easy and safe method for CESD in infants with chronic subdural collections.     

Prospective randomized placebo-controlled double-blind clinical study of adjuvant dexamethasone with surgery for chronic subdural haematoma with post-operative subdural drainage: Interim analysis

Most chronic subdural haematomas (CSDH) are successfully treated neurosurgically. However, operative recurrences occur with a frequency 3–30%, consume resources and potentially prolong length-of stay (LOS). The only adjuvant factor proven to significantly decrease CSDH recurrence rate (RR) is post-operative subdural drainage. Corticosteroids have been used to conservatively manage CSDH. One non-randomised study also compared dexamethasone (DX) as an adjunct to surgery without post-operative drainage: whilst a null effect was observed, the ‘surgery-alone’ group consisted of only n = 13. We present an interim analysis of the first registered prospective randomised placebo-controlled trial (PRPCT) of adjuvant DX on RR and outcome after CSDH surgery with post-operative drainage. Participants were randomised to either placebo or a reducing DX regime over 2 weeks, with CSDH evacuation and post-operative drainage. Post-operative mortality (POMT) and RR were determined at 30 days and 6 months; modified Rankin Score (mRS) at discharge and 6 months. Post-operative morbidity (POMB) and adverse events (AEs) were determined at 30 days. Interim analysis at approximately 50% estimated sample size was performed (n = 47). Recurrences were not observed with DX: only with placebo (0/23 [0%] v 5/24 [20.83%], P = 0.049). There was no significant between-group differences in POMT, POMB, LOS, mRS or AEs.ConclusionsIn this first registered PRPCT, interim analysis suggested that adjuvant DX with post-operative drainage is both safe and may significantly decrease recurrences. A 12.5% point between-groups difference may be reasonable to power a final sample size of approximately n = 89. Future studies could consider adjuvant DX for longer than the arbitrarily-chosen 2 weeks.     

Delayed intrapleural migration of a ventriculoperitoneal shunt

We report a case of delayed intrapleural migration of the peritoneal catheter of a ventriculoperitoneal shunt. This is an unusual but life-threatening complication of peritoneal shunting for the treatment of hydrocephalus. A method of treatment and abbreviated review of shunt complications is included.     

脑室-腹腔分流治疗重型颅脑损伤术后脑积水合并硬膜下积液

目的探讨重型颅脑损伤去骨瓣减压术后脑积水合并硬膜下积液行脑室一腹腔分流术（V-P分流术）的治疗效果。方法回顾性分析2009年3月~2012年12月共收治的重型颅脑损伤开颅去骨瓣减压术后脑积水合并硬膜下积液患者的临床资料：9例患者均通过临床表现和影像学检查确诊。其中1例先将硬膜下积液钻孔引流,拔除引流管后硬膜下积液复发,行V-P分流术,其余8例用V-P分流术进行治疗。结果患者出院时进行头颅CT复查,硬膜下积液消退,扩大的脑室缩小或接近正常。随访0．5年～2年：无硬膜下积液复发,无脑积水的临床表现,脑室大小基本正常。本组无死亡病例,按COS评定：良好4例,中残2例,重残2例,植物生存1例。结论对于重型颅脑损伤开颅去骨瓣减压术后脑积水合并硬膜下积液患者,只要硬膜下积液和脑室是自由交通的,用V-P分流手术治疗是有效的和令人满意的。     

经皮穿刺引流术治疗开颅去骨瓣减压术后硬膜下积液的疗效分析

目的探讨经皮穿刺引流术治疗开颅去骨瓣减压术后硬膜下积液的疗效分析。 方法选择爱德堡医院神经外科自2008年8月至2018年5月收治的60例开颅去骨瓣减压术后硬膜下积液患者为研究对象。根据患者病情及其家属意愿将采用经皮穿刺引流术治疗的患者设为观察组（30例）,采用腰椎穿刺引流术治疗的患者设为对照组（30例）,比较2组患者的治疗总有效率、治愈时间以及并发症的发生情况。 结果同对照组治疗总有效率（70.00%）比较,观察组的治疗总有效率（96.67%）获得明显提升（P<0.05）。对照组治愈时间为（12.69±2.13）d,观察组治愈时间为（7.78±1.24）d,观察组明显短于对照组（t=8.912,P=0.000）。2组患者术后均未发生颅内积气及感染,对照组出现穿刺点脑脊液漏3例,观察组出现头皮切口漏液2例,对症处理后均消失,差异无统计学意义（P>0.05）。 结论开颅去骨瓣减压术后硬膜下积液患者选择经皮穿刺引流术治疗,可以获得明显减压效果。     

Facial nerve palsy—an unusual complication after evacuation of a subdural haematoma or hygroma in children

Objective This paper reports and discusses on the possible etiology of postoperative contralateral facial nerve palsy after uneventful evacuation of a subdural haematoma or hygroma after mild head trauma in two children with pre-existing middle cranial fossa subarachnoid cysts.Results Two 14- and 15-year-old boys had prolonged headaches after mild head injuries. CT showed a right-sided middle cranial fossa arachnoid cyst in each patient. In one patient, an ipsilateral subdural haematoma was identified, and in the other, bilateral hygromas were identified. Exacerbation of symptoms required emergency evacuation of the subdural haematoma in the first child, and bilateral external drainage of the hygroma in the other child. In both children the late postoperative period was complicated by peripheral facial nerve palsies contralateral to the arachnoid cyst.Conclusion Facial nerve palsy may be a complication of hygroma or haematoma drainage. The etiology is not clear; traction of the facial nerve due to displacement of the brainstem may be the most likely explanation.     

老年外伤性硬膜下积液178例临床分析

外伤性硬膜下积液(traumatic subdural effusion,TSE)又名外伤性硬脑膜下水瘤,常见于颅脑损伤后.颅脑损伤时,脑组织在颅腔内发生较强位移,导致蛛网膜被撕破.脑脊液流到硬脑膜下和蛛网膜之间的硬脑膜下间隙,聚集形成积液.TSE发生率大约为颅脑损伤的1％.其中老年患者发病率更高.TSE诊断和治疗过程较为复杂,常熟市中医院自2006年4月至2011年3月共收治老年重型TSE患者178例,占同期颅脑损伤患者的9.8％,经积极救治后预后较为满意,现报道如下.     

Visualization of an actively bleeding cortical vessel into the subdural space by CT angiography

Spontaneous subdural hematomas of arterial origin are rare with only a few published case reports in the literature. In the CT era, vessel imaging of extra-axial hematomas is not commonly performed. In this case report we present a patient with a large, spontaneous acute subdural hematoma that demonstrated active contrast extravasation from a small cortical vessel on CT angiography. During surgical evacuation the vessel was confirmed to be a small cortical artery that was bulging through the arachnoid membrane and bleeding into the subdural space. The historical, radiographic, and clinical aspects of this unusual cause of subdural hematoma are discussed.     

Unusual proximal migration of ventriculoperitoneal shunt into the heart

Quite a number of cases of upward shunt migration have already been reported in the literature. In this paper, the intracardiac migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by a plain radiograph of the chest and a direct open heart surgery. To the author's knowledge this is the first reported case of migration of a peritoneal shunt tube into the heart. The authors postulate possible mechanisms and a physioanatomical explanation on the basis of the surgical findings.     

Complete migration of peritoneal shunt tubing to the scalp

The entire length of distal tubing from a ventriculoperitoneal shunt was found to have migrated into the subgaleal space, and resulted in a shunt obstruction. Upward migration of distal shunt catheters has rarely been reported, but probably involves patient motion that creates a windlass effect. Cephaled migration requires a potential space (subgaleal or ventricular) and no resistance to movement of the tubing. This complication can be prevented by securing the shunt near the site of motion.     

Arachnoid cyst associated with subdural hematoma: report of three cases and review of the literature

Introduction  Arachnoid cysts are usually found incidentally and are generally asymptomatic. They are thought to be developmental anomalies, and their etiology is unknown. Some complications such as subdural hematoma, subdural hygroma, and intracystic bleeding can occur after minor traumas. Case report  Here, we report three cases. Case 1 has subdural hematoma associated with subdural hygroma, case 2 has subdural hematoma after a birth delivery, and case 3 has intracystic bleeding associated with subdural hematoma. Discussion  We suggest to treat the complicating event in our patients and have chosen burr-hole evacuation for treatment.     

One trocar laparoscopic placement of peritoneal shunt for hydrocephalus: A simplified technique

Peritoneal catheter placement for the treatment of hydrocephalus can nowadays be performed laparoscopically. We report our experience using a single trocar technique, with emphasis to a modification applied especially for the obese patients.     

CSF hydrothorax – VP shunt complication without displacement of a peritoneal catheter

Cerebrospinal fluid hydrothorax is reported as a rare complication of ventriculoperitoneal (VP) shunt. A 16-month-old boy known to have congenital hydrocephalus and a Dandy-Walker cyst presented with serious respiratory distress. Examination revealed right pleural effusion and congested throat. Thoracocentesis with drainage of the pleural cavity for 10 days failed to free the patient from pleural effusion. Following an intraperitoneal injection of Omnipaque a chest X-ray was done, and samples of pleural fluid taken before and after the injection were compared on X-ray, revealing the presence of contrast in the postinjection pleural effusion. Changing the VP shunt for a ventriculo-atrial shunt resulted in immediate (within 1 day) complete disappearance of the pleural effusion and of the patient's chest symptoms. Probable causes of this rare complication are discussed, and attention is drawn to the possibility of its appearance and early recognition. Intraperitoneal injection of contrast material followed by X-ray examination of fluid in the chest is a simple, safe, and reliable method of diagnosis when it is suspected.     

腹腔分流术治疗儿童外伤性硬膜下积液25例报告

颅内外伤性硬脑膜下腔积液是儿童颅脑外伤的常见疾病,通常出现颅高压症状、癫痫和部分神经功能障碍时需要手术治疗。以往的外科治疗方法以钻孔引流术为主,但是相当一部分患者引流效果不佳,复发率很高,临床症状不易消失。自2002年8月至2005年5月我科共实施硬脑膜下腔积液-腹腔分