Symptomatic contralateral subdural hygromas after decompressive craniectomy: plausible causes and management...

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Contralateral subdural hygromas (CSDHs) can occur after decompressive craniectomy (DC).
• Symptomatic CSDHs (sCSDHs) pose significant management challenges due to unclear etiology.
• This study shares clinical experience in managing sCSDHs post-DC.

Purpose of the Study:

• To evaluate the management and outcomes of symptomatic contralateral subdural collections (CLSDCs) following decompressive craniectomy (DC).
• To identify effective treatment strategies for CLSDCs after DC.

Main Methods:

• Retrospective review of 306 patients undergoing DC over 10 months.
• Identified 17 patients with CLSDC, 7 of whom were symptomatic.
• Symptomatic patients were treated with bur hole drainage followed by cranioplasty, with shunting if hydrocephalus developed.

Main Results:

• Seven patients developed symptomatic CLSDCs (average 24 days post-DC), primarily after head injury.
• Bur hole drainage provided only temporary symptom improvement in 5 patients.
• Cranioplasty resolved CLSDCs in all 7 patients (average 34 days post-cranioplasty); 3 developed hydrocephalus requiring shunting.

Conclusions:

• Arachnoid tears and blocked arachnoid villi are likely causes of CLSDCs, exacerbated by reduced CSF absorption post-DC.
• Bur hole drainage is insufficient for CLSDC resolution; cranioplasty is the definitive treatment.
• Early cranioplasty may prevent CLSDC formation; shunting is necessary for associated hydrocephalus.