Subdural hygromas After Decompressive Craniotomies
https://doi.org/10.35401/2541-9897-2024-9-1-129-135
Abstract
Subdural hygromas occur after various brain interventions, are often asymptomatic but sometimes may require surgical treatment. They can develop in the immediate postoperative period, but they are more common a few weeks or even months after surgery. Subdural hygromas are particularly common after decompressive craniotomy in patients with traumatic brain injury or massive stroke. The pathogenesis is explained by the fact that a large bone defect causes a pressure difference in the skull, and a concomitant displacement of the ventricular system disrupts the normal cerebrospinal fluid circulation, contributing to the redistribution of cerebrospinal fluid flow into the subdural space.
We review data from contemporary studies on subdural hygromas after decompressive craniotomy, their risk factors, and management strategies. We also present our case of recurrent subdural hygroma in a patient operated on for a ruptured aneurysm of the middle cerebral artery.
About the Authors
P. G. Shnyakin
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Regional Clinical Hospital
Russian Federation
Russian Federation
Pavel G. Shnyakin, Dr Sci. (Med.), Head of the Department of Traumatology, Orthopedics and Neurosurgery
Krasnoyarsk
A. V. Botov
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Regional Clinical Hospital
Russian Federation
Russian Federation
Anton V. Botov, Cand. Sci. (Med.), Associate Professor at the Department of Traumatology, Orthopedics and Neurosurgery
Krasnoyarsk
P. G. Rudenko
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;
Regional Clinical Hospital
Russian Federation
Russian Federation
Pavel G. Rudenko, Cand. Sci. (Med.), Assistant Professor at the Department of Traumatology, Orthopedics and Neurosurgery
Krasnoyarsk
A. S. Loseva
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
Russian Federation
Russian Federation
Anastasia S. Loseva, Resident, Department of Traumatology, Orthopedics and Neurosurgery
Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, ulitsa Partizana Zheleznyaka 1, Krasnoyarsk, 660022
References
1. Paredes I, Cicuendez M, Delgado MA, Martinez-Pérez R, Munarriz PM, Lagares A. Normal pressure subdural hygroma with mass effect as a complication of decompressive craniectomy. Surg Neurol Int. 2011;2:88. PMID: 21748040. PMCID: PMC3130440. https://doi.org/10.4103/2152-7806.82370
2. Wu R, Ye Y, Ma T, Jia G, Qin H. Management of subdural effusion and hydrocephalus following decompressive craniectomy for posttraumatic cerebral infarction in a patient with traumatic brain injury: a case report. BMC Surg. 2019;19(1):26. PMID: 30813919. PMCID: PMC6391787. https://doi.org/10.1186/s12893-019-0489-5
3. Mork J, Mraček J, Štěpánek D, Runt V, Přibáň V. Surgical complications of decompressive craniectomy in patients with head injury. Rozhl Chir. 2020;99(7):316–322. PMID: 32972150. https:// doi.org/10.33699/PIS.2020.99.7.316-322
4. Kim BO, Kim JY, Whang K, et al. The risk factors of subdural hygroma after decompressive craniectomy. Korean J Neurotrauma. 2018;14(2):93–98. PMID: 30402425. PMCID: PMC6218352. https://doi.org/10.13004/kjnt.2018.14.2.93
5. Yuan Q, Wu X, Yu J, et al. Subdural hygroma following decompressive craniectomy or non-decompressive craniectomy in patients with traumatic brain injury: clinical features and risk factors. Brain Inj. 2015;29(7–8):971–980. PMID: 25915113. https://doi.org/10.3109/02699052.2015.1004760
6. Park J, Cho JH, Goh DH, Kang DH, Shin IH, Hamm IS. Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors. J Neurosurg. 2016;124(2):310– 317. PMID: 26275003. https://doi.org/10.3171/2015.1.JNS14309
7. Signorelli F, Ioannoni E, Olivi A, Montano N. Factors involved in the development of subdural hygroma after decompressive craniectomy for traumatic brain injury. A systematic review and meta-analysis. J Clin Neurosci. 2020;78:273–276. PMID: 32402617. https://doi.org/10.1016/j.jocn.2020.05.033
8. Kilincer C, Simsek O, Hamamcioglu MK, Hicdonmez T, Cobanoglu S. Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature. Clin Neurol Neurosurg. 2005;107(5):412–416. PMID: 16023537. https://doi.org/10.1016/j.clineuro.2004.09.018
9. Salunke P, Garg R, Kapoor A, Chhabra R, Mukherjee KK. Symptomatic contralateral subdural hygromas after decompressive craniectomy: plausible causes and management protocols. J Neurosurg. 2015;122(3):602–609. PMID: 25495740. https://doi.org/10.3171/2014.10.JNS14780
10. Su FW, Ho JT, Wang HC. Acute contralateral subdural hygroma following craniectomy. J Clin Neurosci. 2008;15(3):305–307. PMID: 18182295. https://doi.org/10.1016/j.jocn.2006.08.019
11. Aarabi B, Chesler D, Maulucci C, Blacklock T, Alexander M. Dynamics of subdural hygroma following decompressive craniectomy: acomparativestudy. Neurosurg Focus. 2009;26(6):E8. PMID: 19485721. https://doi.org/10.3171/2009.3.FOCUS0947
12. Santana-Cabrera L, Pérez-Acosta G, Rodríguez-Escot C, Lorenzo-Torrent R, Sánchez-Palacios M. Complications of post-injury decompressive craniectomy. Int J Crit Illn Inj Sci. 2012;2(3):186–188. PMID: 23181215. PMCID: PMC3500013. https://doi.org/10.4103/2229-5151.100937
13. Krishnan P, Roy Chowdhury S. Recurrent, symptomatic, late-onset, contralateral subdural effusion following decompressive craniectomy treated by cranial strapping. Br J Neurosurg. 2015;29(5):730–732. PMID: 26037938. https://doi.org/10.3109/02688697.2015.1039485
14. Akins PT, Guppy KH. Are hygromas and hydrocephalus after decompressive craniectomy caused by impaired brain pulsatility, cerebrospinal fluid hydrodynamics, and glymphatic drainage? Literature overview and illustrative cases. World Neurosurg. 2019;130:e941–e952. PMID: 31302278. https://doi.org/10.1016/j.wneu.2019.07.041
15. Jeon SW, Choi JH, Jang TW, Moon SM, Hwang HS, Jeong JH. Risk factors associated with subdural hygroma after decompressive craniectomy in patients with traumatic brain injury: a comparative study. J Korean Neurosurg Soc. 2011;49(6):355–358. PMID: 21887394. PMCID: PMC3158479. https://doi.org/10.3340/jkns.2011.49.6.355
16. Kaen A, Jimenez-Roldan L, Alday R, et al. Interhemispheric hygroma after decompressive craniectomy: does it predict posttraumatic hydrocephalus?. J Neurosurg. 2010;113(6):1287– 1293. PMID: 20486895. https://doi.org/10.3171/2010.4.JNS10132
17. De Bonis P, Sturiale CL, Anile C, et al. Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: a timeline of events?. Clin Neurol Neurosurg. 2013;115(8):1308–1312. PMID: 23290122. https://doi.org/10.1016/j.clineuro.2012.12.011
18. Tanaka Y, Mizuno M, Kobayashi S, Sugita K. Subdural fluid collection following craniotomy. Surg Neurol. 1987;27(4):353–356. PMID: 3824141. https://doi.org/10.1016/0090-3019(87)90010-3
19. Tsuang FY, Huang AP, Tsai YH, et al. Treatment of patients with traumatic subdural effusion and concomitant hydrocephalus. J Neurosurg. 2012;116(3):558–565. PMID: 22175725. https://doi.org/10.3171/2011.10.JNS11711
20. Guo H, Zhou X, Li X, Yang S, Wang Y. Scenario for the use of effusion-peritoneal shunt necessary against subdural effusion secondary to decompressive craniectomy. Clin Neurol Neurosurg. 2021;203:106598. PMID: 33730617. https://doi.org/10.1016/j.clineuro.2021.106598
21. Ling H, Yang L, Huang Z, et al. Contralateral subdural effusion after decompressive craniectomy: what is the optimal treatment?. Clin Neurol Neurosurg. 2021;210:106950. PMID: 34583274. https://doi.org/10.1016/j.clineuro.2021.106950
22. Srivastava C, Sahoo SK, Ojha BK, Chandra A, Singh SK. Subdural hygroma following endoscopic third ventriculostomy: understanding the pathophysiology. World Neurosurg. 2018;118:e639–e645. PMID: 30017758. https://doi.org/10.1016/j.wneu.2018.07.011
23. Nasi D, Dobran M, Iacoangeli M, Di Somma L, Gladi M, Scerrati M. Paradoxical brain herniation after decompressive craniectomy provoked by drainage of subdural hygroma. World Neurosurg. 2016;91:673.e1–673.e6734. PMID: 27108031. https://doi.org/10.1016/j.wneu.2016.04.041
24. Wang HK, Lu K, Liang CL, Tsai YD, Wang KW, Liliang PC. Contralateral subdural effusion related to decompressive craniectomy performed in patients with severe traumatic brain injury. Injury. 2012;43(5):594–597. PMID: 20615502. https://doi.org/10.1016/j.injury.2010.06.004
25. Zhou W, Wang Z, Zhu H, et al. Effects of cranioplasty on contralateral subdural effusion after decompressive craniectomy: a literature review. World Neurosurg. 2022;165:147–153. PMID: 35779748. https://doi.org/10.1016/j.wneu.2022.06.117
26. Wan Y, Shi L, Wang Z, et al. Effective treatment via early cranioplasty for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury. Clin Neurol Neurosurg. 2016;149:87–93. PMID: 27500656. https://doi.org/10.1016/j.clineuro.2016.08.004
27. Gorbunov NS, Narodov AA, Erahtin EE, Zalevskij AA. Constitutional approach to the treatment of patients with brain tumors. Siberian Medical Review. 2013;(3):47–51. (In Russ.). https://doi.org/10.20333/25000136-2013-3-47-51
Review
For citations:
Shnyakin P.G., Botov A.V., Rudenko P.G., Loseva A.S. Subdural hygromas After Decompressive Craniotomies. Innovative Medicine of Kuban. 2024;(1):129-135. (In Russ.) https://doi.org/10.35401/2541-9897-2024-9-1-129-135
Views:
1565
Email this article 
