Related Experiment Video
Updated: Sep 30, 2026
Accessing the Subdural Space of the Rodent Spinal Cord for Treatment Delivery
Published on: August 8, 2025
Surgical treatment of chronic subdural hygromas in infants and children
M Caldarelli1, C Di Rocco, R Romani
1Department of Neurosurgery, Section of Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy.
Insights
Chronic subdural fluid collections in children are often linked to surgery or infections. Both external drainage and subdural-peritoneal shunts are effective treatments, leading to good neurological outcomes.
Area of Science:
- Neurosurgery
- Paediatric Medicine
- Neurology
Background:
- Extra-axial chronic fluid collections are common in children under two.
- Management of these collections remains a subject of debate.
- This review analyzes 72 cases managed between 1984 and 2000.
Purpose of the Study:
- To review the management strategies for chronic subdural fluid collections in paediatric patients.
- To evaluate the effectiveness of different treatment modalities.
Main Methods:
- Patients were categorized by aetiology: post-surgical (47%), post-infectious (20%), post-traumatic (18%), and idiopathic (15%).
- Treatments included temporary subdural external drainage (SED), subdural-peritoneostomy (SPS), and craniotomy with neomembrane resection.
- Collections were analyzed for laterality (unilateral 47%, bilateral 53%).
Main Results:
- Subdural external drainage (SED) was used in 48% of cases, with 26 successful outcomes.
- Subdural-peritoneostomy (SPS) was performed in 61% of cases, including failures from SED.
- Craniotomy was performed in 4% of patients. Good results were achieved with both drainage methods, with excellent radiological and clinical outcomes.
- Unilateral drainage was effective for bilateral collections.
Conclusions:
- Both subdural external drainage and subdural-peritoneostomy are effective for paediatric chronic subdural fluid collections.
- Treatment choice depends on the specific case, with generally favorable outcomes.
- Further research may refine optimal management strategies.
Background:
Extra-axial chronic fluid collections are pathological conditions occurring more frequently in the paediatric age, particularly in children less than two-year-old. Although recognised for many years and repeatedly reported in the literature, some aspects of their treatment are still under debate. This review of the management of chronic subdural collections is based on our experience of 72 cases treated between January 1984 and December 2000.
Method:
Patients were divided into four groups according to aetiology. Thirty-four cases (47%) occurred following various surgical procedures; 14 cases (20%) occurred as complications of leptomeningeal infections; 13 cases (18%) were post-traumatic, whereas no obvious aetiology could be detected in the last 11 cases (15%). The collections were unilateral in 34 patients (47%) and bilateral in the other 38 (53%).
Findings:
Thirty-five patients (48%) were treated by means of a temporary subdural external drainage (SED) (for a total of 38 SED procedures), which was maintained for a mean of 5.8 (+/-3.4) days; it was effective in 26 cases, whereas in the other 9 it was necessary to perform a subdural-peritoneostomy (SPS). Three of these 38 SEDs were complicated by infection. In one more child the external drainage was complicated by a chronic subdural haematoma. A SPS was performed in 44 cases (61%), 9 being failed external drainages. Only in 16 (38%) of these 44 patients the SPS was removed after an average of 27.0 (+/-16.6) months. Three patients (4%) were treated by craniotomy and resection of the neomembranes lining the subdural fluid collection. Obstruction of the SPS occurred in 6 children, infection in 4. Good results were obtained with either external or internal drainage. In fact post-operative neuroradiological investigation disclosed in all the cases complete or almost complete cerebral re-expansion; also the clinical outcome was generally very good, although largely dependent upon the basic clinical condition. Unilateral subdural-peritoneal and/or external drainage was effective also in case of bilateral collections. Only 2 patients required temporary bilateral external drainage.
