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[Reduction cranioplasty for a case of intractable chronic subdural hematoma in infancy]
K Tsutsumi1, T Asano, T Shigeno
1Department of Neurosurgery, Saitama Medical Center.
Insights
This case report details a modified reduction cranioplasty for an infant with chronic subdural hematoma and brain atrophy. The novel surgical technique achieved excellent outcomes, offering a new treatment option for complex pediatric CSDH cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Trauma Surgery
Background:
- Infantile chronic subdural hematoma (CSDH) typically resolves with standard treatments.
- Progressive craniocerebral disproportion in infants with CSDH necessitates specialized therapeutic approaches.
- Reduction cranioplasty has been explored for these challenging cases.
Observation:
- A 9-month-old male infant presented with intractable, bilateral, large CSDH and subsequent brain atrophy following head trauma.
- A modified reduction cranioplasty technique was employed to address the complex CSDH and associated complications.
Findings:
- The modified reduction cranioplasty involved a T-shaped incision, bilateral frontoparietal craniotomy preserving the superior sagittal sinus (SSS), and ligation of the SSS and falx.
- Complete evacuation of the subdural hematoma was achieved through an extensive dural opening.
- Postoperative reconstruction included trimming bone flaps and removing excess scalp, resulting in excellent outcomes.
Implications:
- This modified reduction cranioplasty offers a potentially effective surgical solution for infantile CSDH with progressive craniocerebral disproportion.
- The technique may help prevent complications like postoperative kinking of the SSS.
- Successful management of such complex cases can lead to improved neurological outcomes in affected infants.
Abstract:
Although almost all infants suffering chronic subdural hematomas (CSDH) are successfully treated by established methods such as a subdural puncture, burr holes and shunting procedures, infantile CSDH with progressive craniocerebral disproportion requires a special therapeutical regimen. Clinical efforts such as reduction cranioplasty have been made as a treatment for these cases. This is a case report of a 9-month-old male infant with an intractable CSDH, bilateral and large, and subsequent brain atrophy caused by traumatic head injury. Excellent results were obtained by a modified reduction cranioplasty. In brief, the patient was supine-positioned with a 20-degree flexion of the head in an attempt to obtain a large operative field. Bicoronal skin incision was combined with an additional linear one on the midline (T-shaped incision). Bilateral frontoparietal craniotomy with periosteum was made to keep the midline bony bridge overlying the superior sagittal sinus (SSS). The resulting extensive dural opening allowed complete evacuation of the subdural hematoma. Thereafter, the anterior part, ca. 4cm in width, of the bony bridge was removed in order to make the remaining bone able to be manipulated and connected to the frontal bone. Prior to this stage, SSS close to the crista galli was ligated and cut with the falx to avoid postoperative kinking. The dura mater was sutured so as not to leave an excessive subdural space. The bone flaps were trimmed to complete a good-shaped reconstruction. Finally, the excessive scalp was removed because the original scalp was too large for the reconstructed skull.(ABSTRACT TRUNCATED AT 250 WORDS)