Tension pneumocephalus is rare complication is neurosurgical operation. But it should be treated promptly because of sudden neurological deterioration. Computed tomography permitted rapid diagnosis including localization of the air, thus facilitating prompt treatment. A case of subdural tension pneumocephalus after cranial operation under the impression of bifrontal subdural hygroma is presented.
Diagnosis ; Pneumocephalus* ; Subdural Effusion

Three cases of chronic subdural hematoma superimposed on posttraumatic subdural hygroma are presented, with discussion of the development of the chronic subdural hematoma particularly. In all of these three cases the chronic subdural hematoma had occurred consequently to the posttraumatic subdural hygroma, but these diagnoses were done in variable periods of 20 days to 60 days. Therefore, it is suggested that the posttraumatic subdural hygroma have, at least, some relation to the genesis of the chronic subdural hematoma.
Diagnosis ; Hematoma, Subdural, Chronic* ; Subdural Effusion*

This study has been made to stress the importance of fracture pattern of the posterior fossa for recognition of traumatic lesions in the posterior fossa. Included in the series are all the cases of clinically significant verified lesions in the posterior fossa due to posterior fossa fractures. The classification of posterior fossa fractures introduced here by author has been based on the linear fracture involving the transverse sinus groove and/or the foramen magnum in Towne's projection. Five types of pattern have occurred. In type I, a linear fracture involves the transverse sinus groove and the foramen magnum. In type II, a linear fracture involves the transverse sinus groove but not the foramen magnum. In type III, a linear fracture involves the lambdoid suture, the transverse sinus groove and the foramen magnum. In type IV, a linear fracture involves the lambdoid suture and the transverse sinus groove, but not the foramen magnum. In type V, a linear fracture of the suboccipital bone involves the foramen magnum, but not the transverse sinus groove. In a total of 33 cases of posterior fossa fracture, 13 cases(39.3%) are of type I, 7 cases(21.2%) are of type II, 5 cases(15.2%) are of type III, 5 cases(15.2%) are of type IV, 3 cases(9.1%) are of type V. It has been shown that the cerebellar hematomas have been verified in type I, epidural and subdural hematomas verified in all the types without regard to the fracture patterns, and subdural hygromas verified in type I, III and V.
Classification ; Foramen Magnum ; Hematoma ; Hematoma, Subdural ; Subdural Effusion ; Sutures

The authors report a series of 40 cases of traumatic subdural hygroma and discuss the clinical and radiological features, management, surgical results, and pathogenesis. The "simple hygroma" accounted for majority of cases (78%) and among "complex hygroma" cases, subdural hematoma was most often accompanied. Skull fractures was found in 33% of cases. Bilateral subdural hygroma were seen in 67% and delayed onset were noted in 10 cases(25%). Changes in mental status without focal signs of neurologic deficit was noted in over 50% of cases. Although 75% of cases showed full recovery, clinical course marked by persistence of neurologic deficit was noted in 12.5% of cases. Operation was underwent in 72% and simple burr hole drainage was done in most of cases. Reaccumulation rate was relatively high (27.5%) after initial operation. The mortality rate was 12.5.
Drainage ; Hematoma, Subdural ; Mortality ; Neurologic Manifestations ; Skull Fractures ; Subdural Effusion*

Traumatic subdural hygroma has received little attention in the literature, the authors experienced 17 cases of traumatic subdural hygroma after introduction of Computerized Tomography(CT) since October 1977 in Kyung Hee University Hospital. Characteristics in CT of our experienced traumatic subdural hygromas were almostly bilateral and located on the anterior aspect of the interhemispheric fissure, frontal and frontotemporal side with decrease density as like cerebrospinal fluid. Subdural hygroma easily differentiated with subdural hematoma by use of the CT scan. Subdural hygroma usually respond readily to evacuation of watery yellowish or cerebrospinal fluid-like fluid through simple burr hole, conservative treatment effected only 3 cases out of 17 subdural hygromas.
Cerebrospinal Fluid ; Hematoma, Subdural ; Subdural Effusion* ; Tomography, X-Ray Computed

In the management of hydrocephalus by shunts, two valve types are currently available:1) differential pressure valves(DPV) which provide a constant resistance and allow CSF flow when the proximal hydrostatic pressure exceeds the valve's present closing pressure, and 2) the newer variable resistance flow regulated valve(FRV). Eighty one cases of hydrocephalus were reviewed in this study to compare the two devices. Forty two patients were operated with FRV and 39 patients were operated with DPV. This study compared the preoperative and postoperative KPS score, ventricular size, periventricular low densities, and the frequency of complications. We have conclude that 1) In group 1(KPS score 50-70), FRV is useful and in group 2(KPS score 20-40), DPV is useful, 2) FRV is useful in dealing with excessively reduced ICP caused by over-drainage of a ventricular shunt;it can prevent postshunt subdural hygroma and symptomatic slit ventricles. 3) For evaluation of the effectiveness of FRV, the decrease of periventricular low densities is a more valuable index than the change of ventricle size(Hydrocephalus index).
Humans ; Hydrocephalus ; Hydrostatic Pressure ; Subdural Effusion ; Ventriculoperitoneal Shunt*

The occurrence of subdural hygroma following pterional approach for intracranial aneurysm at Yeungnam University from March 1994 to December 1994 was studied with regard to the patients age, location of aneurysm, preoperative ventricular dilatation, operation time, cortex color, CSF flow, opening degree of Liliequist membrane, dissection degree of sylvian fissure, postoperative intradural air amount and day for mannitol infusion using chi-square test. The following results and conclusions were obtained: 1) Subdural hygroma was observed in 28 of 53 patients(52.8%). 2) The patient's age was significantly related to the occurance of subdural hygroma(p<0.05). 3) CSF flow through the basal cistern was significantly related to the occurrence of subdural hygroma(p<0.05). 4) In cases of good CSF flow, degree of Lilieqist membrane opening was significantly related to the occurrence of subdural hygroma(p<0.05). Preserving of Liliequist membrane will minimize the occurrence of subdural hygroma.
Aneurysm ; Dilatation ; Humans ; Intracranial Aneurysm* ; Mannitol ; Membranes ; Subdural Effusion*

The authors analysed 140 cases of subdural hygroma developed after head injury and various neurosurgical operations and was treated at Hanyang university hospital from 1983 to 1989. The results were analysed and summarized as follows. 1) The peak incidence was the age over 50 and under 10. 2) 104 cases(74.4%) were bilateral frontotemporoparietal lesions. 3) Causes were head injury(121 cases), operation for intracranial aneurysms(5 cases), ventriculoperitoneal shunt(5 cases), traumatic(2 cases), external ventricular drainage(1 case). 4) Change in mental status without focal sign of brain damage was presenting symptom. 5) Operation was underwent if 63 cases and the reaccumulation rate was high (26.8%) after trephination but outcome was favorable. 6) Mortality rate in traumatic subdural hygroma was low(5.8%) because brain CT could detect subdural hygroma easily in early stage.
Brain ; Craniocerebral Trauma ; Head ; Incidence ; Mortality ; Subdural Effusion* ; Trephining

OBJECTIVE: The goal of this study was to clarify the value of the programmable valve shunt system to readjust the pressure noninvasively for the adequate cerebrospinal fluid(CSF) drainage. METHODS: The authors analyzed a single-center retrospective study of 54 patients suffering from hydrocephalus of various causes, as aneurysm(21 patients), trauma(13 patients), normal-pressure hydrocephalus(NPH, 7 patients) and so on. In 51 cases a programmable valve was implanted at the first shunt implantation. In three cases the shunt was replaced to a programmable valve system. RESULTS: In 33 patients(61%) of cases valve pressure adjustment was required at least once(total number of readjustment 54, mean 1.7, maximum 5) for the reason of underdrainage(36) or overdrainge(18). The range of reprogrammed valve pressure was 10 to 90mmH2O(mean 11.1+/-15.9mmH2O), the radiological finding improved 48.6% of frontal horn index at the beginning of reprogramming to 41.3%, and the clinical symptom related with hydrocephalus improved in 29 patients(87.8%) of pressure adjustment. Shunt reprogramming was necessary in patients with congenital hydrocephalus(100%), aneurysm(55%), NPH(71%), trauma(50%); the programmable valve proved particularly beneficial for overdrainge as subdural hygroma. CONCLUSION: The programmable valve was useful for the correction of overdrainge or underdrainage by the easy control of valve pressure without any invasive procedure.
Animals ; Drainage ; Horns ; Humans ; Hydrocephalus* ; Retrospective Studies ; Subdural Effusion

Subdural hygromas are easily treated by trephination and drainage. Therefore, most neurosurgeons do not consider subdural hygromas seriously. However, various complications including intracerebral hemorrhage may develop after rapid drainage of subdural hygroma although rare. Postoperative intracerebral hemorrhage presents with a rapid deterioration of consciousness and focal neurological deficits occurring immediately after drainage of the subdural hygroma. The authors present an unfortunate massive intracerebral hemorrhage and pneumocephalus following drainage of the bifrontal subdural hygroma. The patient subsequently died. To prevent this disastrous complication, close neurosurgical observation and gradual drainage under a closed system seem mandatory. Possible pathogenic mechanisms for this unfavorable complication is discussed with a review of pertinent literatures.
Cerebral Hemorrhage* ; Consciousness ; Drainage* ; Humans ; Pneumocephalus ; Subdural Effusion* ; Trephining