Studies Of Diagnosis And Treatment Of Subdural Hygroma After Decompressive Craniectomy For Traumatic Brain Injury

Objective To investigate the formation and treatment methods of subdural hygroma after traumatic decompressive craniectomyMethods 31 cases of subdural hygroma after decompressive craniectomy were retrospectivly reviewed. Its clinical manifestations, results of CT scanning and treatment methods were analyzed and the patients were followed to evaluvate the prognosis.Results Among these 31 patients, 22 were male and 9 were female, with an average of 41±6.4 years old(18-71 years old). The initial CT scan results: the unilateral fronto-temperal brian contusion and SDH were 20 cases; The bilateral fronto-temperal brian contusion and SDH were 7 cases; the unilateral fronto-temperal ICH was 1 case; The bilateral fronto-temperal brian contusion and contralateral EDH was 1 case; The bilateral EDH was 1 case. The subdural hygroma was found 7-34 days after decompressive craniectomy, with an average time of 24±6 days. The subdural hygroma was located in fronto-temperal regions in 11 cases, in frontotempero-parietal in 13 cases.The CT value of the subdural hygroma was 7-24 Hu, with an average of 16 ±3 Hu and the wideth of the subdural hygroma was1.25±0.4cm, with an average of 0.81±0.24 cm. In patients with decreased level of consciousness by head CT revealed subdural hygroma were 10 cases and decompression window bulging and head CT revealed subdural hygroma accompanied with hydrocephalus were 13 cases. Because of subdural hygroma volume increasing leading to unilateral pupil dialation was 1 case. In this group, conservative treatment was made in all cases, in which 6 cases, condation were reduced because of the subdural hygroma.2 cases were performed burr hole, in which 1 case recurrenced after extubation and was performed subdural-peritoneal shunt. 2 cases were performed local puncture and the effusion recurrenced, then the patients were performed V-P shunt. 2 cases were performed lumbar cistern tube drainage, but the effusion recrrenced and the ventricular system dilated after the tube was removed. 2 cases the effusion disappear, but the ventricular syetem dilated. 23 cases subdural hygroma accompanied with hydrocephalus were performed V-P shunt, in which 2 cases were performed V-P shunt and cranioplasty and with an average of 17 days the hygroma diminished and the ventricular system was normal.Conclusions The survivors of TBI performed with DC treatment, the subdural hygroma was diversity.It can appear in the same side or contralateral side of decompression window or bilateral sides of the shull and may be combined with interhemisphaerica hygroma.If the volume of the subdural hygroma was small, it can disappear when the hydrocephalus was formed.But if the volume was large,it can lead to subdural hygroma accompanied with hydrocephalus.ventriculo-peritoneal shunt was an effective treatment for those patients.