We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolved in 12 (20.7%), reduced in 15 (25.9%), remained in 10 (17.2%), enlarged in 2 (3.4%), and changed into chronic subdural hematoma (CSDH) in 19 patients (32.8%). SDG was diagnosed at 11.6 days after the injury. It was enlarged at 25.5 days, remained at 46.0 days, reduced at 59.3 days, resolved at 107.5 days, and changed into CSDH at 101.5 days in average. SDGs were developed as delayed lesions, and changed sequentially. They enlarged for a while, then reduced in size. The final path of a SDG was either resolution or CSDH formation. Nearly half of SDGs was resolved or reduced within three months, however, 61.3% of unresolved or unreduced SDG became iso- or hyperdense CSDH. These results suggest that the unresolved SDG is the precursor of CSDH.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Craniocerebral Trauma/complications ; Disease Progression ; Hematoma, Subdural, Chronic/radiography* ; Hematoma, Subdural, Chronic/pathology* ; Hematoma, Subdural, Chronic/etiology ; Human ; Infant ; Longitudinal Studies ; Lymphangioma/radiography ; Lymphangioma/pathology ; Lymphangioma/etiology ; Middle Age ; Subdural Effusion/radiography* ; Subdural Effusion/pathology* ; Subdural Effusion/etiology ; Tomography, X-Ray Computed*

Brain Stem ; pathology ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; adverse effects ; Postoperative Complications ; Subdural Effusion ; complications

Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.
Brain ; Catheters ; Cerebrospinal Fluid ; Craniotomy* ; Endoscopy* ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Hydrocephalus* ; Hydrodynamics ; Length of Stay ; Membranes ; Neurosurgery ; Pathology ; Subdural Effusion

The brain and intracranial compartment undergo a multiplicity of physiologic and anatomical changes which influence the type of head injury and response to such injury, especially for those children in first two years of age in whom development of skull and brain is still undertaking. Thus, special attention to recognize and manage these children from such injury seems mandatory. Purpose of this study is to analyze the related causes for the head injury in this age group with various clinical parameters influencing the outcome. A total of 68 children less than two years of age who were admitted to our institution after head trauma were included in this retrospective study. The causes of head injury along with other clinical settings, such as type of pathologies, Pediatric Glassgow Coma Scale(PGCS), age, operation, hypoxia, shock, seizure, anemia, abnormal pupillary response, were reviewed and clinical outcome related with these parameters were analysed. The mean duration of admission period was 15 days and mean follow-up period was 29.4 months. Most common mode of injury was stairway injury(32.3%), followed by in-car accident(19.1%), with suspected child abuse being only 2.9%. Cerebral contusion was the most frequent diagnosis being 43 cases(63.2%), followed by skull fracture in 31(45.6%). For the outcome related to various categories, 5 cases of death were due to diffuse axonal injury or intracranial hemorrhage, but most simple linear fractures were not associated with underlying brain injury. Among those required the operation(18 cases), subdural and/or epidural hematoma were the most common pathology(50%), followed by subdural hygroma and depressed skull fracture. The outcome, however, was not related to type of pathology. Instead, it was rather closely related to the initial PGCS. The PGCS at admission was found out to be the major predicting factor to outcome. In overall, 34/36(94.4%) cases with normal PGCS in these age groups showed good recovery with deaths being 5/7(71.4%) cases of PGCS Anemia ; Anisocoria ; Anoxia ; Brain ; Brain Injuries ; Child Abuse ; Child* ; Coma ; Contusions ; Craniocerebral Trauma* ; Diagnosis ; Diffuse Axonal Injury ; Fever ; Follow-Up Studies ; Head* ; Hematoma ; Humans ; Hypotension ; Intracranial Hemorrhages ; Mortality ; Mortuary Practice ; Pathology ; Prognosis ; Reflex ; Retrospective Studies ; Seizures ; Shock ; Skull ; Skull Fracture, Depressed ; Skull Fractures ; Subdural Effusion