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External subdural drainage in the treatment of infantile chronic subdural hematoma
Chih-Lung Lin1, Shiuh-Lin Hwang, Yu-Feng Su
1Division of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. chihlung1@yahoo.com
Insights
Continuous external subdural drainage effectively treats chronic subdural hematoma (CSDH) in infants, showing a low complication rate. This method is a viable initial strategy before considering shunting for infantile CSDH.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Management
Background:
- Management of chronic subdural hematoma (CSDH) in infants is debated.
- Infantile CSDH presents unique diagnostic and therapeutic challenges.
Purpose of the Study:
- To analyze clinical characteristics of infantile CSDH.
- To evaluate continuous external subdural drainage efficacy for infantile CSDH.
Main Methods:
- Prospective collection of 36 infants with CSDH.
- Initial management with continuous external subdural drainage.
- Diagnosis via CT and/or MRI; outcomes assessed post-treatment.
Main Results:
- Head injury and shaken baby syndrome were primary causes.
- Seizures and consciousness disturbance were common presentations.
- Continuous external subdural drainage was successful in 94.4% of cases with good recovery in 63.9%.
Conclusions:
- Continuous external subdural drainage is effective for infantile CSDH.
- Low complication rates and good outcomes support its use.
- Consider continuous external subdural drainage as a primary strategy before shunting.
Background:
The management of chronic subdural hematoma (CSDH) in infants remains controversial. The purpose of this study was to analyze the clinical characteristics of CSDH in infancy and evaluate the efficacy of continuous external subdural drainage in the treatment of infantile CSDH.
Methods:
We prospectively collected 36 consecutive infants with CSDH, to receive continuous external subdural drainage as the initial management. Medical records were reviewed for comparison of age, gender, cause of injury, clinical presentation, surgical management, and outcome. Diagnosis was made by computed tomography and/or magnetic resonance imaging.
Results:
There were 20 boys and 16 girls, with ages ranging from 1 to 11 months (average, 5.9 months). The most common cause of CSDH was head injury (44.5%), followed by shaken baby syndrome (36.1%). The most common clinical presentations were seizure, bulging fontanel, and consciousness disturbance. Continuous external subdural drainage was the definite treatment in 34 patients (94.4%). The drains were left in place for no more than 9 days. Only two (5.6%) patients needed permanent subduroperitoneal shunting. No obvious complication was found. At follow-up (17-160 months; mean, 86.6 months), 23 (63.9%) had good recovery, 5 (13.9%) had moderate disability, 3 (8.3%) had severe disability, 4 (11.1%) were in a vegetative state, and 1 (2.8%) died.
Conclusion:
Continuous external subdural drainage was an effective treatment in infantile CSDH, with a low complication rate and good clinical outcome. It might be considered as a strategy before subduroperitoneal shunting in the treatment of CSDH in infants.
