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Subdural-atrial and subdural-peritoneal shunting in infants with chronic subdural fluid collections
M C Korinth1, B Lippitz, L Mayfrank
1Department of Neurosurgery, Technical University, Aachen, Germany.
Insights
For infants with chronic subdural fluid collections, subdural-peritoneal shunts offer a safe and effective treatment when repeated tapping fails. This method led to symptom resolution and fluid collection reduction in all cases.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Device Technology
Background:
- Chronic subdural fluid collections in infants present a management challenge.
- Treatment options include observation, tapping, drainage, and craniotomy, with no universally agreed-upon standard.
- Etiologies for these collections are diverse, complicating treatment decisions.
Purpose of the Study:
- To evaluate the efficacy and safety of subdural-peritoneal and subdural-atrial shunts in infants with symptomatic chronic subdural fluid collections.
- To assess the outcomes of shunt placement in cases refractory to less invasive treatments.
Main Methods:
- A retrospective analysis of 8 infants (mean age 7 months) with bifrontal subdural hygromas/hematomas.
- Treatment involved subdural-peritoneal or subdural-atrial shunts after initial failure of repeated subdural taps.
- Follow-up data on clinical and neuroradiologic outcomes were collected.
Main Results:
- All infants were initially symptomatic; repeated tapping provided no benefit.
- Shunt placement led to complete resolution of clinical signs in all infants.
- Complete fluid collection removal occurred in 6 cases, with significant improvement in 2.
- One case required shunt removal due to infection, with no long-term adverse effects.
- No recurrences were observed during follow-up.
Conclusions:
- Early unilateral subdural-peritoneal shunt placement with a low-pressure valve is a safe and effective option for infants with symptomatic chronic subdural fluid collections unresponsive to tapping.
- Shunt treatment offers a favorable alternative to more invasive procedures in select pediatric neurosurgical cases.
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.