Kazuya Matsuo1,2, Nobuyuki Akutsu3, Kunitoshi Otsuka4, Kazuki Yamamoto5, Atsufumi Kawamura3, Tatsuya Nagashima3. 1. Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo, 654-0081, Japan. kkmatsuo@outlook.jp. 2. Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. kkmatsuo@outlook.jp. 3. Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-Ku, Kobe, Hyogo, 654-0081, Japan. 4. Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan. 5. Department of Neurosurgery, Kakogawa Hospital Organization, Kakogawa West-City Hospital, 384-1 Hiratsu, Yoneda-cho, Kakogawa, Hyogo, 675-8611, Japan.
Abstract
PURPOSE: Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2 years old. We also aimed to determine the predictors of CSDH/SDHy recurrence. METHODS: We conducted a retrospective chart review of 25 children under 2 years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period. We analyzed the relationship between CSDH/SDHy recurrence and factors such as abusive head trauma, laterality of CSDH/SDHy, and subdural fluid collection type (hematoma or hygroma). RESULTS: CSDH/SDHy recurred in 5 of the 25 patients (20 %), requiring a second operation at an average of 0.92 ± 1.12 months after the initial procedure. The mean follow-up period was 25.1 ± 28.6 months. There were no complications related to either operation. None of the assessed factors were statistically associated with recurrence. CONCLUSIONS: Burr-hole craniotomy without continuous drainage for CSDH/SDHy appears safe in children aged under 2 years and results in a relatively low recurrence rate. No predictors of CSDH/SDHy recurrence were identified. Advantages of this method include avoiding external subdural drainage-related complications. However, burr-hole drainage may be more effective for CSDH, which our data suggests is more likely to recur than SDHy, providing the procedure is performed with specific efforts to reduce complications.
PURPOSE: Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2 years old. We also aimed to determine the predictors of CSDH/SDHy recurrence. METHODS: We conducted a retrospective chart review of 25 children under 2 years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period. We analyzed the relationship between CSDH/SDHy recurrence and factors such as abusive head trauma, laterality of CSDH/SDHy, and subdural fluid collection type (hematoma or hygroma). RESULTS:CSDH/SDHy recurred in 5 of the 25 patients (20 %), requiring a second operation at an average of 0.92 ± 1.12 months after the initial procedure. The mean follow-up period was 25.1 ± 28.6 months. There were no complications related to either operation. None of the assessed factors were statistically associated with recurrence. CONCLUSIONS: Burr-hole craniotomy without continuous drainage for CSDH/SDHy appears safe in children aged under 2 years and results in a relatively low recurrence rate. No predictors of CSDH/SDHy recurrence were identified. Advantages of this method include avoiding external subdural drainage-related complications. However, burr-hole drainage may be more effective for CSDH, which our data suggests is more likely to recur than SDHy, providing the procedure is performed with specific efforts to reduce complications.
Entities:
Keywords:
Abusive head trauma; Irrigation; Recurrence; Subdural fluid collection
Authors: Thomas Santarius; Peter J Kirkpatrick; Dharmendra Ganesan; Hui Ling Chia; Ibrahim Jalloh; Peter Smielewski; Hugh K Richards; Hani Marcus; Richard A Parker; Stephen J Price; Ramez W Kirollos; John D Pickard; Peter J Hutchinson Journal: Lancet Date: 2009-09-26 Impact factor: 79.321
Authors: Tessa Sieswerda-Hoogendoorn; Stephen Boos; Betty Spivack; Rob A C Bilo; Rick R van Rijn Journal: Eur J Pediatr Date: 2011-10-28 Impact factor: 3.183