Ventriculosubgaleal shunting for acute head trauma

In 12 cases of closed head injury without fracture or hematoma, but with clinical signs of increased intracranial pressure (ICP) and brain stem compression and with computed tomographic (CT) scan evidence of cerebral edema and contusion, subgaleal shunts were inserted for immediate decompression of the ventricular system and continuous drainage of hemorrhagic cerebrospinal fluid (CSF). Three patients with fixed dilated pupils and no reflexes or spontaneous respiration on admission did not improve and expired within 72 h. Nine patients who manifested Cushing's triad (bradycardia, bradypnea, and hypertension) shortly after admission made significant recovery and underwent catheter removal 1 wk later; 8 were able to be discharged home after extended periods of physiotherapy. No complications, postoperative hemorrhage or infection, were recorded.