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Cranial Neurosurgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Overdrainage can result in low-pressure headaches, which are typically worse on standing. Collapse of the ventricles can cause accumulation of fluid or blood in the subdural space, resulting in subdural hygroma or subdural haematoma. The slit ventricle syndrome describes the situation in children treated with shunts, whose ventricles and subarachnoid spaces are underdeveloped, resulting in poor brain compliance. In these patients normal fluctuations in ICP are exaggerated so that coughing and straining may cause symptoms of raised ICP. Any shunt blockage may not be evident on scan, as the ventricles fail to enlarge.
Trauma from child abuse
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Charles S. Cox, Margaret L. Jackson, Benjamin M. Aertker
CT of the brain is critical in the management of traumatic brain injury (TBI). MRI is less readily available in the acute setting. Thus CT is the primary imaging modality for central nervous system (CNS) trauma in most institutions. Occasionally a definite diagnosis is difficult because of the small and incompletely myelinated pediatric brain. Three-dimensional reconstructions of head CT images can be helpful in differentiating fractures from normal variants [17]. MRI can be useful in the less acute setting to more precisely define chronic abnormalities. A class II study compared two groups of patients with similar Glasgow Coma Scores and perinatal histories, categorizing the TBI as either accidental or inflicted [18]. Patients with inflicted TBI had higher rates of subdural, interhemispheric, and convexity hemorrhages and signs of pre-existing abnormalities such as cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly. Subdural hygroma occurred exclusively in patients with inflicted TBI with atrophy, suggesting a previously undetected TBI. Intraparenchymal hemorrhage, shear injury, and skull fractures were more frequent after accidental TBI.
Neurology and Non-Traumatic Spinal Imaging
Published in Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain, On Call Radiology, 2015
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain
The main differential diagnoses include extradural haematoma (EDH) and subdural hygroma. SDHs are crescenteric in morphology and can cross sutures; conversely, extradural haematomas are lenticular and are bound by sutures (however they can cross the midline and venous sinus reflections). Extradural haematomas are also more commonly associated with skull vault fractures, although this finding does not preclude a subdural collection. Differentiation between chronic SDH and subdural hygroma can be difficult. Subdural hygroma presents as a CSF density subdural collection through which vessels may be seen traversing; however, it does not extend into the sulcal spaces.
Repair of ventricular wall by pericranial flap: a valuable option?
Published in British Journal of Neurosurgery, 2023
Alessandro di Rienzo, Roberto Colasanti, Erika Carrassi, Maurizio Iacoangeli
At immediate post-operative CT, the hygroma was reduced in size, with initial re-expansion of the right hemisphere (Figure 3(A)). No subcutaneous CSF collection was visible. The patient gradually improved, recovering consciousness and full power. The EVD was closed on the 4th post-operative day and removed two days later. One month post-operatively he was asymptomatic and the flap looked healthy. A three-months post-operative CT showed complete resolution of the residual subdural hygroma (Figure 3(B)). Six months later he suffered a deterioration in consciousness and MRI showed tumor dissemination along the entire ventricular system and local regrowth inside the frontal lobe, with pericranial flap infiltration (Figure 3(C)). No further surgery was performed and he died 2 weeks later.
Ruptured intra-cranial arachnoid cysts: a case series from a single UK institution
Published in British Journal of Neurosurgery, 2021
Samuel Hall, Alexander Smedley, Susruta Manivannan, Nijaguna Mathad, Ryan Waters, Aabir Chakraborty, Owen C. Sparrow, Vassilios Tsitouras
Eleven patients (79%) underwent surgical intervention for treatment of symptoms related to mass effect from a ruptured cyst. Of eight patients presenting with subdural haemorrhage, seven required surgical intervention. This included burr-hole drainage (n = 3), mini-craniotomy (n = 2), and craniotomy (n = 2) for evacuation of the subdural haemorrhage. The latter two procedures were combined with cyst fenestration (n = 1) or marsupialisation (n = 1), respectively. All four patients with subdural hygroma required surgical intervention, consisting of burr-hole drainage (n = 2), insertion of subdural-peritoneal shunt (n = 1), and mini-craniotomy and cyst fenestration (n = 1). Of the two patients that were treated with burr-hole drainage, one also underwent microsurgical cyst fenestration through an expanded burr hole. Conservatively managed patients included two patients with intra-cystic haemorrhage and one patient with a small volume chronic subdural haematoma.
Malignant cerebral edema after cranioplasty: a case report and literature review
Published in Brain Injury, 2023
Shaoxiong Wang, Yongxin Luan, Tao Peng, Guangming Wang, Lixiang Zhou, Wei Wu
A 45-year-old man underwent a right intracranial hematoma removal and decompression craniectomy in a local hospital due to a traffic accident in March 2021. His condition gradually improved and then he was released from the hospital 1 month after the surgery. After 2 months of rehabilitation, the patient was measured to reach a GCS score of 14 but left a bone defect in the right frontal-temporal-parietal-occipital part of the skull. Physical examination of the patient on the admission to our center on July 06, 2021 revealed as following: the patient was fluent in speech; bulging of palpable mass through the skull defect was examined, of which volatility was positive; the pupils on both sides were of the same size in circular shape, with 3.0 mm as diameter, and sensitive to light reflection; normal right limb activity was observed, whereas left hemiplegia was examined, no meningeal irritation was tested. The Computed Tomography (CT) of the head at the time of admission revealed a subdural hygroma on the right side of the parietal-occipital region. Following consideration of the formation of the capsule, we performed a subdural effusion capsule resection on July 10, 2021. The cyst fluid is pale yellow cerebrospinal fluid, approximately 150 ml in volume. After the cyst fluid was studied for pathogenic microorganisms, no bacteria were cultured. The postoperative status of the patient was similar to he was before the surgery (Figure 1). Subdural hydromel formed again at 1 week after surgery, and capsular resection did not effectively relieve the subdural hydrogen. Therefore, we intended to perform cranioplasty for the patient (Figure 2).