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Subdural hygroma as a complication of endoscopic neurosurgery--two case reports
Dirk Freudenstein1, Alexandra Wagner, Ulrike Ernemann
1Department of Neurosurgery, University Hospital-Eberhard-Karls-University Tübingen, Tübingen, Germany. dkfreude@med.uni-tuebingen.de
Abstract:
Two cases of subdural hygroma occurred in a series of 77 neuroendoscopic procedures. An 8-year-old boy underwent neuroendoscopic cysto-cisternostomy of a left temporal arachnoid cyst. Routine postoperative magnetic resonance imaging 7 days later showed a large left-sided subdural hygroma without clinical symptoms. During the following 3 months, the subdural hygroma did not resolve spontaneously, so it was drained through a burr hole. A 3-month-old boy with aqueductal stenosis developed bilateral subdural hygromas after third ventriculostomy. Several punctures through the open anterior fontanelle relieved the hygromas but increasing head circumference required ventriculoperitoneal shunting 12 months later. Complications of neuroendoscopic procedures are increasingly reported, including various kinds of bleeding, infections, or damage of neuronal tissue. Only three previous cases of subdural hygroma or hematoma after neuroendoscopic interventions have been reported. The possible etiologies and clinical consequences of this rare complication have to be considered before selecting neuroendoscopy treatment.
Insights
Subdural hygromas are a rare complication following neuroendoscopic procedures. Careful consideration of potential risks is crucial before opting for neuroendoscopic interventions.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Minimally Invasive Neurological Surgery
Background:
- Neuroendoscopy is a minimally invasive surgical technique used for various intracranial procedures.
- Complications associated with neuroendoscopy include bleeding, infection, and neural tissue damage.
- Subdural hygromas are an infrequently reported complication of neuroendoscopic interventions.
Observation:
- Two pediatric cases of subdural hygroma are presented following neuroendoscopic procedures.
- Case 1: An 8-year-old boy developed a symptomatic subdural hygroma after cysto-cisternostomy, requiring surgical drainage.
- Case 2: A 3-month-old infant with aqueductal stenosis developed bilateral subdural hygromas post-third ventriculostomy, eventually needing a shunt.
Findings:
- Subdural hygromas can occur as a delayed complication after neuroendoscopy.
- These hygromas may not resolve spontaneously and can necessitate further intervention.
- The occurrence of subdural hygromas highlights the need for vigilant postoperative monitoring.
Implications:
- The potential for subdural hygroma formation should be considered in the risk-benefit analysis of neuroendoscopy.
- Further research into the specific etiologies of post-neuroendoscopic subdural hygromas is warranted.
- Understanding and anticipating rare complications can improve patient outcomes in neuroendoscopic surgery.
