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*

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*

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

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

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

OBJECTIVE: To evaluate the advantages of Medos Hakim programmable valve system in the treatment of various type of hydrocephalus. MATERIALS AND METHODS: We retrospectively analyzed 33 patients who underwent ventriculoperitoneal shunt with Medos Hakim programmable valve system from December 1995 to June 1998. They were followed from 1 month to 35 months(mean 10.6 months). RESULTS: The overall outcome were excellent in 8 patients, improvement but residual symptoms in 16 patients and unchanged in 9 patients. There were 8 complications; overdrainage with subdural fluid collections(4 cases), infections(2 cases), obstruction(1 case) and mechanical failure(1 case). Overdrainage with subdural fluid collections was managed by readjustment of valve operating pressure alone in 3 cases and by observation in 1 case. Readjustment of valve pressure was needed more in children than in adults. There was significant correlation between opening and final pressure and the opening pressure was important for choosing the initial valve operating pressure at the time of implantation. CONCLUSION: In this study, we found that the Medos Hakim programmable valve is beneficial in cases with slowly progressive hydrocephalus and very large ventricles, especially in children, in order to normalize the ventricle size slowly with avoiding subdural hygromas.
Adult ; Child ; Humans ; Hydrocephalus* ; Retrospective Studies ; Subdural Effusion ; Ventriculoperitoneal Shunt

Spontaneous Intracranial Hypotension(SIH) is a rare syndrome of spontaneous postural cephalalgia associated with low CSF pressure and usually without evidence of CSF leakage from meningeal defect due to dural puncture. The postural headache may appear suddenly or gradually and disappear within several weeks spontaneously. MRI findings maybe include diffuse symmetric pachymeningeal gadolinium-enhancement, also subdural effusion and downward brain displacement. We report two cases of SIH in which MRI of the brain reveals diffuse symmetric pachyme-ningeal enhancement.
Brain ; Headache ; Intracranial Hypotension* ; Magnetic Resonance Imaging* ; Punctures ; Subdural Effusion

OBJECTIVE: There is no definite adjustment protocol for patients shunted with programmable valves. Therefore, we attempted to find an appropriate method to adjust the valve, initial valve-opening pressure, adjustment scale, adjustment time interval, and final valve-opening pressure of a programmable valve. METHODS: Seventy patients with hydrocephalus of various etiologies were shunted with programmable shunting devices (Micro Valve with RICKHAM(R) Reservoir). The most common initial diseases were subarachnoid hemorrhage (SAH) and head trauma. Sixty-six patients had a communicating type of hydrocephalus, and 4 had an obstructive type of hydrocephalus. Fifty-one patients had normal pressure-type hydrocephalus and 19 patients had high pressure-type hydrocephalus. We set the initial valve pressure to 10-30 mmH2O, which is lower than the preoperative lumbar tapping pressure or the intraoperative ventricular tapping pressure, conducted brain computerized tomographic (CT) scans every 2 to 3 weeks, correlated results with clinical symptoms, and reset valve-opening pressures. RESULTS: Initial valve-opening pressures varied from 30 to 180 mmH2O (mean, 102 +/- 27.5 mmH2O). In high pressure-type hydrocephalus patients, we have set the initial valve-opening pressure from 100 to 180 mmH2O. We decreased the valve-opening pressure 20-30 mmH2O at every 2- or 3-week interval, until hydrocephalus-related symptoms improved and the size of the ventricle was normalized. There were 154 adjustments in 81 operations (mean, 1.9 times). In 19 high pressure-type patients, final valve-opening pressures were 30-160 mmH2O, and 16 (84%) patients' symptoms had nearly improved completely. However, in 51 normal pressure-type patients, only 31 (61%) had improved. Surprisingly, in 22 of the 31 normal pressure-type improved patients, final valve-opening pressures were 30 mmH2O (16 patients) and 40 mmH2O (6 patients). Furthermore, when final valve-opening pressures were adjusted to 30 mmH2O, 14 patients symptom was improved just at the point. There were 18 (22%) major complications : 7 subdural hygroma, 6 shunt obstructions, and 5 shunt infections. CONCLUSION: In normal pressure-type hydrocephalus, most patients improved when the final valve-opening pressure was 30 mmH2O. We suggest that all normal pressure-type hydrocephalus patients be shunted with programmable valves, and their initial valve-opening pressures set to 10-30 mmH2O below their preoperative cerebrospinal fluid (CSF) pressures. If final valve-opening pressures are lowered in 20 or 30 mmH2O scale at 2- or 3-week intervals, reaching a final pressure of 30 mmH2O, we believe that there is a low risk of overdrainage syndromes.
Brain ; Craniocerebral Trauma ; Humans ; Hydrocephalus ; Subarachnoid Hemorrhage ; Subdural Effusion

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*