Subdural-atrial and subdural-peritoneal shunting in infants with chronic subdural fluid collections

BACKGROUND: In symptomatic infants with chronic subdural fluid collections a variety of treatment strategies, such as observation, repeated subdural tapping, external or internal subdural drainage, and craniotomy have been advocated. Until now, the ideal management for this etiologically heterogenous group of children seems controversial. METHODS: The authors present their treatment with subdural-peritoneal and subdural-atrial shunts and the follow-up in 8 infants (mean age, 7 months) with bifrontal subdural hygromas and hematomas caused by different etiologic conditions. RESULTS: Initially, all children were symptomatic, and repeated subdural taps showed no clinical and neuroradiologic benefit. Shunting resulted in disappearance of all clinical signs in all infants, with complete removal of the chronic subdural fluid collections in 6 cases and remarkable improvement in 2 cases. In all infants the shunt system was removed after disappearance of signs and decrease of fluid collections. As the only complication the shunt system had to be removed in 1 case on the fourth postoperative day because of infection without any further disadvantages. In none of the cases was a recurrence of the fluid collections seen during the follow-up. CONCLUSION: These results suggest that in infants with symptomatic chronic subdural fluid collections who fail to respond to repeated tapping, the early placement of an unilateral subdural-peritoneal shunt with a low pressure valve represents a safe, benign, and effective treatment option.