Dynamics of subdural hygroma following decompressive craniectomy: a comparative study.

OBJECT This retrospective comparative cohort study was aimed at discovering the risk factors associated with subdural hygroma (SDG) following decompressive craniectomy (DC) to relieve intracranial hypertension in severe head injury. METHODS Sixty-eight of 104 patients who had undergone DC during a 48-month period and survived > 30 days were eligible for this study. To assess the dynamics of subdural fluid collections, the authors compared CT scanning data from and the characteristics of 39 patients who had SDGs with the data in 29 patients who did not have hygromas. Variables significant in the appearance, evolution, and resolution of this complication were analyzed in a 36-week longitudinal study. RESULTS The earliest imaging evidence of SDG was seen during the 1st week after DC. The SDG volume peaked between Weeks 3 and 4 post-DC and was gradually resolved by the 17th week. Among the mechanisms of injury, motor vehicle accidents were most often linked to the development of an SDG after DC (p < 0.0007), and falls were least often associated (p < 0.005). Moreover, patients with diffuse brain injury were more prone to this complication (p < 0.0299) than those with an evacuated mass (p < 0.0001). There were no statistically significant differences between patients with and without hygromas in terms of age, sex, Glasgow Coma Scale score, intraventricular and subarachnoid hemorrhage, levels of intracranial pressure and cerebral perfusion pressure, timing of decompression, and the need for CSF diversion. More than 90% of the SDGs were ipsilateral to the side of the craniectomy, and 3 (8%) of 39 SDGs showed evidence of internal bleeding at approximately 8 weeks postinjury. Surgical evacuation was needed in 4 patients with SDGs. CONCLUSIONS High dynamic accidents and patients with diffuse injury were more prone to SDGs. Close to 8% of SDGs converted themselves into subdural hematomas at approximately 2 months postinjury. Although SDGs developed in 39 (approximately 60%) of 68 post-DC patients, surgical evacuation was needed in only 4.

[1]  Mostafa El-Feky,et al.  SUBDURAL hygroma. , 2011, Lancet.

[2]  J. Simard,et al.  COMPARATIVE STUDY OF DECOMPRESSIVE CRANIECTOMY AFTER MASS LESION EVACUATION IN SEVERE HEAD INJURY , 2009, Neurosurgery.

[3]  Steven E. Katz,et al.  Cerebrospinal fluid outflow: An evolving perspective , 2008, Brain Research Bulletin.

[4]  R. Zhan,et al.  Contralateral Subdural Effusion Secondary to Decompressive Craniectomy Performed in Patients with Severe Traumatic Brain Injury: Incidence, Clinical Presentations, Treatment and Outcome , 2008, Medical Principles and Practice.

[5]  R. Zhan,et al.  Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases , 2008, Acta Neurochirurgica.

[6]  Seong-Hyun Park,et al.  Chronic subdural hematoma preceded by traumatic subdural hygroma , 2008, Journal of Clinical Neuroscience.

[7]  R. Zhan,et al.  Efficacy of large decompressive craniectomy in severe traumatic brain injury. , 2008, Chinese journal of traumatology = Zhonghua chuang shang za zhi.

[8]  Hung-Chen Wang,et al.  Acute contralateral subdural hygroma following craniectomy , 2008, Journal of Clinical Neuroscience.

[9]  J. Praetorius.  Water and solute secretion by the choroid plexus , 2007, Pflügers Archiv - European Journal of Physiology.

[10]  M. Johnston,et al.  Quantification of cerebrospinal fluid transport across the cribriform plate into lymphatics in rats. , 2006, American journal of physiology. Regulatory, integrative and comparative physiology.

[11]  Bizhan Aarabi,et al.  Outcome following decompressive craniectomy for malignant swelling due to severe head injury. , 2006, Journal of neurosurgery.

[12]  R. Friendship,et al.  Development of cerebrospinal fluid absorption sites in the pig and rat: connections between the subarachnoid space and lymphatic vessels in the olfactory turbinates , 2006, Anatomy and Embryology.

[13]  S. Nielsen,et al.  Distribution of sodium transporters and aquaporin‐1 in the human choroid plexus , 2006, American journal of physiology. Cell physiology.

[14]  G. Murray,et al.  The Management of Patients with Intradural Post-Traumatic Mass Lesions: A Multicenter Survey of Current Approaches to Surgical Management in 729 Patients Coordinated by the European Brain Injury Consortium , 2005, Neurosurgery.

[15]  M. Johnston,et al.  Subarachnoid injection of Microfil reveals connections between cerebrospinal fluid and nasal lymphatics in the non‐human primate , 2005, Neuropathology and applied neurobiology.

[16]  R. Tuncer,et al.  Role of decompressive surgery in the management of severe head injuries: prognostic factors and patient selection. , 2005, Journal of neurotrauma.

[17]  D. Backous,et al.  Basic principles of cerebrospinal fluid metabolism and intracranial pressure homeostasis. , 2005, Otolaryngologic clinics of North America.

[18]  C. Kılınçer,et al.  Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature , 2005, Clinical Neurology and Neurosurgery.

[19]  Jun Zhang,et al.  Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. , 2005, Journal of neurotrauma.

[20]  Hasan Kamil Sucu,et al.  The Value of XYZ/2 Technique Compared With Computer-Assisted Volumetric Analysis to Estimate the Volume of Chronic Subdural Hematoma , 2005, Stroke.

[21]  G. Manley,et al.  Reduced cerebrospinal fluid production and intracranial pressure in mice lacking choroid plexus water channel Aquaporin‐1 , 2005, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[22]  R. Zafonte,et al.  Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. , 2001, The Journal of trauma.

[23]  P. Horn,et al.  Management of severe traumatic brain injury by decompressive craniectomy. , 2001, Neurosurgery.

[24]  J. Pickard,et al.  Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension , 2001, British journal of neurosurgery.

[25]  Charles Teo,et al.  Disorders of CSF hydrodynamics , 2000, Child's Nervous System.

[26]  H. Bae,et al.  The fate of traumatic subdural hygroma in serial computed tomographic scans. , 2000, Journal of Korean medical science.

[27]  D. Frim,et al.  A Theoretical Model of Benign External Hydrocephalus That Predicts a Predisposition towards Extra-Axial Hemorrhage after Minor Head Trauma , 2000, Pediatric Neurosurgery.

[28]  K. Mori,et al.  Delayed magnetic resonance imaging with GdD-DTPA differentiates subdural hygroma and subdural effusion. , 2000, Surgical neurology.

[29]  E. Markakis,et al.  Elevated cerebral perfusion pressure and low colloid osmotic pressure as a risk factor for subdural space-occupying hygromas? , 1999, Surgical neurology.

[30]  D S Yoo,et al.  Ventricular pressure monitoring during bilateral decompression with dural expansion. , 1999, Journal of neurosurgery.

[31]  M. Kunnen,et al.  Posttraumatic subdural hygroma: CT findings and differential diagnosis. , 1999, JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie.

[32]  E J Topol,et al.  Comparison of the ABC/2 estimation technique to computer-assisted volumetric analysis of intraparenchymal and subdural hematomas complicating the GUSTO-1 trial. , 1998, Stroke.

[33]  N. Tisdale,et al.  Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. , 1997, Neurosurgery.

[34]  M. Boulton,et al.  Lymphatic drainage of the CNS: effects of lymphatic diversion/ligation on CSF protein transport to plasma. , 1997, The American journal of physiology.

[35]  K. Murata.  Chronic subdural hematoma may be preceded by persistent traumatic subdural effusion. , 1993, Neurologia medico-chirurgica.

[36]  P. Agre,et al.  Distribution of the aquaporin CHIP in secretory and resorptive epithelia and capillary endothelia. , 1993, Proceedings of the National Academy of Sciences of the United States of America.

[37]  M. Sofroniew,et al.  Serum Proteins Bypass the Blood-Brain Fluid Barriers for Extracellular Entry to the Central Nervous System , 1993, Experimental Neurology.

[38]  Anthony Marmarou,et al.  A new classification of head injury based on computerized tomography , 1991 .

[39]  Beth S. Lee,et al.  Functional expression and subcellular localization of an anion exchanger cloned from choroid plexus. , 1990, Proceedings of the National Academy of Sciences of the United States of America.

[40]  K. Ohno,et al.  Chronic subdural haematoma preceded by persistent traumatic subdural fluid collection. , 1987, Journal of neurology, neurosurgery, and psychiatry.

[41]  H. Nukui,et al.  Postoperative subdural fluid collections in neurosurgery. , 1987, Surgical neurology.

[42]  P. Flandroy,et al.  [Incidence and treatment of subdural hygroma in severe head injuries]. , 1984, Acta neurologica Belgica.

[43]  T. Ohta,et al.  Immunohistochemical localization of Na+, K+-ATPase in the choroid plexus , 1984, Brain Research.

[44]  K. Jakobsson,et al.  Extracerebral non-haemorrhagic expansive complications of intracranial surgery , 1983, Acta Neurochirurgica.

[45]  C. Perria,et al.  Traumatic subdural hygromas: a report of 70 surgically treated cases. , 1983, Journal of neurosurgical sciences.

[46]  C. Dila,et al.  Traumatic subdural hygroma in adults. , 1981, Neurosurgery.

[47]  Y. Nagaseki,et al.  Traumatic Subdural Hygromas in Adults , 1981 .

[48]  R. P. Greenberg,et al.  Alterations in ventricular size and intracranial pressure caused by sagittal sinus pathology in man. , 1980, Journal of neurosurgery.

[49]  B. Weir.  Oncotic pressure of subdural fluids. , 1980, Journal of neurosurgery.

[50]  Endtz Lj.  Post-traumatic hygroma in the eighteenth century: described by Thomas Schwencke. , 1978 .

[51]  E. Wright,et al.  An electrogenic NA+/K+ pump in the choroid plexus. , 1978, Biochimica et biophysica acta.

[52]  R. Friede,et al.  The origin of subdural neomembranes. I. Fine structure of the dura-arachnoid interface in man. , 1978, The American journal of pathology.

[53]  B. N. French,et al.  Delayed evolution of posttraumatic subdural hygroma. , 1978, Surgical neurology.

[54]  H F Cserr,et al.  Bulk flow of interstitial fluid after intracranial injection of blue dextran 2000. , 1974, Experimental neurology.

[55]  R. Tripathi,et al.  Vacuolar transcellular channels as a drainage pathway for cerebrospinal fluid , 1974, The Journal of physiology.

[56]  J. Hoff,et al.  Traumatic subdural hygroma. , 1973, The Journal of trauma.

[57]  E. Rabe,et al.  Subdural collections of fluid in infants and children: A study of 62 patients with special reference to factors influencing prognosis and the efficacy of various forms of therapy , 1968, Neurology.

[58]  K. Welch,et al.  SECRETION OF CEREBROSPINAL FLUID BY CHOROID PLEXUS OF THE RABBIT. , 1963, The American journal of physiology.

[59]  E. Rabe,et al.  A study of subdural effusions in an infant , 1962, Neurology.

[60]  J. D. Rougemont,et al.  FLUID FORMED BY CHOROID PLEXUS: A TECHNIQUE FOR ITS COLLECTION AND A COMPARISON OF ITS ELECTROLYTE COMPOSITION WITH SERUM AND CISTERNAL FLUIDS , 1960 .

[61]  C. Elsberg,et al.  CHRONIC SUBDURAL ACCUMULATIONS OF CERE-BROSPINAL FLUID AFTER CRANIAL TRAUMA: REPORT OF A CASE , 1927 .

[62]  H. Naffziger.  SUBDURAL FLUID ACCUMULATIONS FOLLOWING HEAD INJURY , 1924 .

[63]  Yao-hua Pan,et al.  Traumatic subdural effusion evolves into chronic subdural hematoma: two stages of the same inflammatory reaction? , 2008, Medical hypotheses.

[64]  D. Menon,et al.  Decompressive craniectomy in traumatic brain injury: outcome following protocol-driven therapy. , 2006, Acta neurochirurgica. Supplement.

[65]  P. Gildenberg,et al.  Post-traumatic subdural hygromas: Observations concerning a surgical enigma , 2005, Acta Neurochirurgica.

[66]  B. Rama,et al.  Protein analysis of subdural hygroma fluid , 2005, Acta Neurochirurgica.

[67]  J. K. Kang,et al.  Spontaneous evolution of posttraumatic subdural hygroma into chronic subdural haematoma , 2005, Acta Neurochirurgica.

[68]  李刚,et al.  Traumatic subdural hydroma developing into chronic subdural hematoma , 2004 .

[69]  K. S. Lee,et al.  The pathogenesis and fate of traumatic subdural hygroma. , 1994, British journal of neurosurgery.

[70]  B. Scheithauer,et al.  The "subdural" space: a new look at an outdated concept. , 1993, Neurosurgery.

[71]  H. Kaufman.  Traumatic subdural hygroma: pathology and meningeal enhancement on magnetic resonance imaging. , 1993, Neurosurgery.

[72]  O Henriksen,et al.  Circadian variation in human cerebrospinal fluid production measured by magnetic resonance imaging. , 1992, The American journal of physiology.

[73]  M. Gaab,et al.  Traumatic brain swelling and operative decompression: a prospective investigation. , 1990, Acta neurochirurgica. Supplementum.

[74]  Y. Nagaseki,et al.  [Traumatic subdural hygromas in adults--on the possibility of development of chronic subdural hematoma (author's transl)]. , 1981, Neurologia medico-chirurgica.

[75]  T. Milhorat,et al.  Flow of cerebral interstitial fluid as indicated by the removal of extracellular markers from rat caudate nucleus. , 1977, Experimental eye research.