Treatment of patients with traumatic subdural effusion and concomitant hydrocephalus

Clinical article

Fon Yih Tsuang, Abel Po Hao Huang, Yi Hsin Tsai, Jo Yu Chen, Jing Er Lee, Yong Kwang Tu, Kuo Chuan Wang

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Object. Traumatic subdural effusion (TSE) is a common sequela of traumatic brain injury. Surgical intervention is suggested only when TSE exerts mass effect. The authors have found that many patients with TSE exerting mass effect have concomitant hydrocephalus. Patient experiencing this occurrence were studied, and the pathogenesis of this phenomenon was discussed in the context of recent advances in the understanding of CSF circulation. Methods. During a 2-year period, the authors' institution treated 14 patients with TSE who developed hydrocephalus, after 1 of the patients suffered subdural drainage and other 13 received subdural peritoneal shunt (SPSs). Thirteen of those who had SPSs received programmable ventriculoperitoneal shunts (VPSs) for the hydrocephalus. The clinical characteristics as well as the imaging and operative findings of these patients were reviewed. Results. All patients with symptomatic TSE exerting mass effect received SPSs. All of these patients had a modified Frontal Horn Index of more than 0.33 at presentation, and high opening pressure on durotomy. Following a brief period (4-7 days) of clinical improvement, the condition of all patients deteriorated due to hydrocephalus. Programmable VPSs were inserted with the initial pressure set at approximately 8-10 cm H 2O according to opening pressure at ventriculostomy. Shunt valve pressure was gradually decreased to 5-7 cm H 2O, according to clinical and radiological follow-up. Conclusions. Elevated modified Frontal Horn Index in patients with TSE is suggestive of concomitant hydrocephalus. The authors propose that tearing of the dura-arachnoid plane following trauma contributes to TSE and may also impede CSF circulation, causing hydrocephalus. Shunt pressure was adjusted to relative low pressure, indicating the old age of the patients and poor reexpansion of brain parenchyma after the mass effect. Subdural peritoneal shunts and VPSs are indicated in those patients with TSE exerting mass effect with concomitant hydrocephalus.

Original languageEnglish
Pages (from-to)558-565
Number of pages8
JournalJournal of Neurosurgery
Volume116
Issue number3
DOIs
Publication statusPublished - Mar 1 2012
Externally publishedYes

Fingerprint

Subdural Effusion
Hydrocephalus
Pressure
Ventriculoperitoneal Shunt
Therapeutics
Horns
Ventriculostomy
Arachnoid
Drainage

Keywords

  • Cerebrospinal fluid
  • Hydrocephalus
  • Subdural effusion
  • Subdural peritoneal shunt
  • Traumatic brain injury
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Treatment of patients with traumatic subdural effusion and concomitant hydrocephalus : Clinical article. / Tsuang, Fon Yih; Huang, Abel Po Hao; Tsai, Yi Hsin; Chen, Jo Yu; Lee, Jing Er; Tu, Yong Kwang; Wang, Kuo Chuan.

In: Journal of Neurosurgery, Vol. 116, No. 3, 01.03.2012, p. 558-565.

Research output: Contribution to journalArticle

Tsuang, Fon Yih ; Huang, Abel Po Hao ; Tsai, Yi Hsin ; Chen, Jo Yu ; Lee, Jing Er ; Tu, Yong Kwang ; Wang, Kuo Chuan. / Treatment of patients with traumatic subdural effusion and concomitant hydrocephalus : Clinical article. In: Journal of Neurosurgery. 2012 ; Vol. 116, No. 3. pp. 558-565.
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abstract = "Object. Traumatic subdural effusion (TSE) is a common sequela of traumatic brain injury. Surgical intervention is suggested only when TSE exerts mass effect. The authors have found that many patients with TSE exerting mass effect have concomitant hydrocephalus. Patient experiencing this occurrence were studied, and the pathogenesis of this phenomenon was discussed in the context of recent advances in the understanding of CSF circulation. Methods. During a 2-year period, the authors' institution treated 14 patients with TSE who developed hydrocephalus, after 1 of the patients suffered subdural drainage and other 13 received subdural peritoneal shunt (SPSs). Thirteen of those who had SPSs received programmable ventriculoperitoneal shunts (VPSs) for the hydrocephalus. The clinical characteristics as well as the imaging and operative findings of these patients were reviewed. Results. All patients with symptomatic TSE exerting mass effect received SPSs. All of these patients had a modified Frontal Horn Index of more than 0.33 at presentation, and high opening pressure on durotomy. Following a brief period (4-7 days) of clinical improvement, the condition of all patients deteriorated due to hydrocephalus. Programmable VPSs were inserted with the initial pressure set at approximately 8-10 cm H 2O according to opening pressure at ventriculostomy. Shunt valve pressure was gradually decreased to 5-7 cm H 2O, according to clinical and radiological follow-up. Conclusions. Elevated modified Frontal Horn Index in patients with TSE is suggestive of concomitant hydrocephalus. The authors propose that tearing of the dura-arachnoid plane following trauma contributes to TSE and may also impede CSF circulation, causing hydrocephalus. Shunt pressure was adjusted to relative low pressure, indicating the old age of the patients and poor reexpansion of brain parenchyma after the mass effect. Subdural peritoneal shunts and VPSs are indicated in those patients with TSE exerting mass effect with concomitant hydrocephalus.",
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AU - Wang, Kuo Chuan

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N2 - Object. Traumatic subdural effusion (TSE) is a common sequela of traumatic brain injury. Surgical intervention is suggested only when TSE exerts mass effect. The authors have found that many patients with TSE exerting mass effect have concomitant hydrocephalus. Patient experiencing this occurrence were studied, and the pathogenesis of this phenomenon was discussed in the context of recent advances in the understanding of CSF circulation. Methods. During a 2-year period, the authors' institution treated 14 patients with TSE who developed hydrocephalus, after 1 of the patients suffered subdural drainage and other 13 received subdural peritoneal shunt (SPSs). Thirteen of those who had SPSs received programmable ventriculoperitoneal shunts (VPSs) for the hydrocephalus. The clinical characteristics as well as the imaging and operative findings of these patients were reviewed. Results. All patients with symptomatic TSE exerting mass effect received SPSs. All of these patients had a modified Frontal Horn Index of more than 0.33 at presentation, and high opening pressure on durotomy. Following a brief period (4-7 days) of clinical improvement, the condition of all patients deteriorated due to hydrocephalus. Programmable VPSs were inserted with the initial pressure set at approximately 8-10 cm H 2O according to opening pressure at ventriculostomy. Shunt valve pressure was gradually decreased to 5-7 cm H 2O, according to clinical and radiological follow-up. Conclusions. Elevated modified Frontal Horn Index in patients with TSE is suggestive of concomitant hydrocephalus. The authors propose that tearing of the dura-arachnoid plane following trauma contributes to TSE and may also impede CSF circulation, causing hydrocephalus. Shunt pressure was adjusted to relative low pressure, indicating the old age of the patients and poor reexpansion of brain parenchyma after the mass effect. Subdural peritoneal shunts and VPSs are indicated in those patients with TSE exerting mass effect with concomitant hydrocephalus.

AB - Object. Traumatic subdural effusion (TSE) is a common sequela of traumatic brain injury. Surgical intervention is suggested only when TSE exerts mass effect. The authors have found that many patients with TSE exerting mass effect have concomitant hydrocephalus. Patient experiencing this occurrence were studied, and the pathogenesis of this phenomenon was discussed in the context of recent advances in the understanding of CSF circulation. Methods. During a 2-year period, the authors' institution treated 14 patients with TSE who developed hydrocephalus, after 1 of the patients suffered subdural drainage and other 13 received subdural peritoneal shunt (SPSs). Thirteen of those who had SPSs received programmable ventriculoperitoneal shunts (VPSs) for the hydrocephalus. The clinical characteristics as well as the imaging and operative findings of these patients were reviewed. Results. All patients with symptomatic TSE exerting mass effect received SPSs. All of these patients had a modified Frontal Horn Index of more than 0.33 at presentation, and high opening pressure on durotomy. Following a brief period (4-7 days) of clinical improvement, the condition of all patients deteriorated due to hydrocephalus. Programmable VPSs were inserted with the initial pressure set at approximately 8-10 cm H 2O according to opening pressure at ventriculostomy. Shunt valve pressure was gradually decreased to 5-7 cm H 2O, according to clinical and radiological follow-up. Conclusions. Elevated modified Frontal Horn Index in patients with TSE is suggestive of concomitant hydrocephalus. The authors propose that tearing of the dura-arachnoid plane following trauma contributes to TSE and may also impede CSF circulation, causing hydrocephalus. Shunt pressure was adjusted to relative low pressure, indicating the old age of the patients and poor reexpansion of brain parenchyma after the mass effect. Subdural peritoneal shunts and VPSs are indicated in those patients with TSE exerting mass effect with concomitant hydrocephalus.

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KW - Subdural peritoneal shunt

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