Related Experiment Videos
Symptomatic calcified subdural hematomas
R R Sharma1, A Mahapatra, S J Pawar
1The National Neurosurgical Center, Khoula Hospital, Mina-Al-Fahal, Muscat, Sultanate of Oman. sharmarr@gto.net.com
Insights
Chronic calcified subdural hematomas are rare long-term complications in children following ventriculoperitoneal shunt surgery for hydrocephalus. Surgical excision led to good recovery in these unique cases.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Complications
Background:
- Ventriculoperitoneal shunts are standard treatment for congenital hydrocephalus.
- Long-term complications, though infrequent, require ongoing vigilance.
- Chronic calcified subdural hematomas are an unusual sequela.
Observation:
- Two pediatric patients with congenital hydrocephalus underwent ventriculoperitoneal shunt placement in infancy.
- Following initial shunt procedures, one patient experienced a subdural collection requiring evacuation.
- Both patients remained asymptomatic for approximately nine years.
Findings:
- Patients presented with acute raised intracranial pressure and hemiparesis.
- CT scans revealed significant mass effect from chronic calcified subdural hematomas.
- Shunt systems were functional, indicating the hematomas were a separate complication.
Implications:
- Highlights a rare but serious long-term complication of ventriculoperitoneal shunts.
- Emphasizes the need for monitoring and considering calcified subdural hematomas in shunt patients with neurological decline.
- Surgical management via craniotomy and hematoma excision offers favorable outcomes.
Abstract:
Two unique cases of chronic calcified subdural hematomas are reported in children as a long-term complication of a ventriculoperitoneal shunt. Both the patients had undergone shunt procedures in infancy for congenital hydrocephalus. In one patient, the cause of the hydrocephalus was aqueduct stenosis, while in the second patient, a lumbar meningomyelocele was associated with hydrocephalus. In both these patients, a ventriculoperitoneal shunt was done in infancy. In one of them, following the shunt surgery, a bilateral subdural collection was noticed which required burr hole evacuation. Both the patients remained asymptomatic for 9 years, when they presented to our center with acute raised intracranial pressure and contralateral hemiparesis. Both the patients had a relatively short history and had altered sensorium at admission. Surprisingly, in both the patients, the CT scan showed significant mass effect producing calcified subdural hematomas. The shunt systems were found to be working well at surgery. Craniotomy and excision of the calcified subdural hematomas was undertaken. Postoperatively, the patients showed satisfactory recovery, and at discharge the patients were doing well. At the follow-up at the outpatient clinic, the patients were asymptomatic.