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Surgical treatment of acute subdural hygroma in children
Insights
Traumatic acute subdural hygromas occurred in 17% of children with acute compressive traumatic intracranial hematoma. Surgical evacuation of hygromatous liquid led to survival in all cases, though some developed hydrocephalus.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Neuroradiology
Background:
- Acute compressive traumatic intracranial hematoma is a serious condition in children.
- Traumatic acute subdural hygromas represent a specific subtype of intracranial hematoma.
- Understanding their incidence and outcomes is crucial for pediatric trauma management.
Purpose of the Study:
- To determine the incidence of traumatic acute subdural hygromas in children operated on for acute compressive traumatic intracranial hematoma.
- To analyze the causes, clinical manifestations, diagnostic methods, and treatment outcomes for these hygromas.
Main Methods:
- Retrospective review of 91 children operated on for acute compressive traumatic intracranial hematoma between 1967-1984.
- Analysis of injury causes, clinical presentations, diagnostic investigations (CT, EEG, etc.), and surgical outcomes.
- Categorization of hygromas as unilateral or bilateral.
Main Results:
- 16% of children (12 unilateral, 4 bilateral) had traumatic acute subdural hygromas.
- Traffic accidents were the most common cause of injury.
- Clinical signs included altered consciousness, palsy, fever, nystagmus, pupillary dilation, and irregular breathing.
- All children survived surgery, but 2 developed hydrocephalus.
Conclusions:
- Traumatic acute subdural hygromas are an identifiable complication in pediatric intracranial hematomas.
- Prompt diagnosis and surgical evacuation via trephination are effective treatments.
- Post-operative hydrocephalus is a potential complication requiring monitoring.
Abstract:
During the years 1967-1984, 91 children were operated on because of acute compressive traumatic intracranial hematoma: 16 (17%) had traumatic acute subdural hygromas. These were unilateral in 12 cases and bilateral in 4. The causes of injury were traffic accidents in 11 children, a fall in 1, and acute deceleration injuries in 5. Nine children suffered multiple injuries to the thorax, inferior extremities, and pelvis. Clinical manifestations and evolution of clinical symptoms included changes in conscious level, palsy, high fever, nystagmus, maximum dilation of either pupil and spontaneous, irregular breathing. The diagnosis was made on the basis of the clinical picture and supplementary clinical investigations: CT, EEG, echoencephalography, isotope cisternography, and arteriography. Treatment was by simple trephination of the cranium and evacuation of hygromatous liquid. All children survived the surgical treatment; 1 child died after the operation and 2 developed hydrocephalus.