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Treatment of a symptomatic posterior fossa subdural effusion in a child
P Van Schaeybroeck1, E Vanlommel, L Lagae
1Department of Neurosurgery, University Hospital Leuven, Belgium. Patrick.vanschaeybroeck@uz.kuleuven.ac.be
Insights
This study reports the first case of posterior fossa subdural effusion causing hydrocephalus and tonsillar herniation in a child. Prompt surgical intervention and drainage led to complete neurological recovery.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Case Study
Background:
- Subdural effusions can lead to serious neurological complications.
- Posterior fossa effusions with secondary hydrocephalus are rare in children.
- Tonsillar herniation indicates significant intracranial pressure.
Observation:
- A 14-month-old girl presented with opisthotonus and signs of raised intracranial pressure.
- The patient had a posterior fossa subdural effusion with secondary hydrocephalus and tonsillar herniation.
- No history of trauma or coagulation disorder was noted.
Findings:
- Initial ventriculo-peritoneal shunt provided only temporary relief.
- External drainage of subdural fluid was ultimately successful.
- Both shunts were removed after resolution of the effusion.
- The patient achieved a complete neurological recovery.
Implications:
- This case highlights the importance of recognizing posterior fossa subdural effusions in pediatric patients.
- Effective management may involve a combination of shunting and direct fluid drainage.
- Further guidelines are proposed for managing these complex cases.
Abstract:
We describe the first observation of a child with a posterior fossa subdural effusion with secondary hydrocephalus and tonsillar herniation. We diagnosed this entity in a 14-month-old girl with no history of trauma or coagulation disorder. The patient presented in our emergency department with opisthotonus and raised intracranial pressure resulting from supratentorial hydrocephalus. An emergency ventriculo-peritoneal shunt was placed, which resolved the symptoms only temporarily. Eventually external drainage of the subdural fluid was performed. The collection gradually disappeared, and both the external subdural shunt and the ventriculo-peritoneal shunt were removed. The patient made a complete neurological recovery. We review the physiopathology and treatment of subdural effusions in general, and propose some guidelines for the management of symptomatic effusions occurring in the posterior fossa in particular.