BACKGROUND: Subdural hematoma is a well-known complication of hydrocephalus shunting procedures. Since the advent of modern neuroimaging techniques, a more realistic incidence of subdural hematomas in shunted patients has been recognized. The description of several asymptomatic cases raises the problem of choosing the most appropriate therapeutic policy for such a condition. METHODS: We report two cases with long standing hydrocephalus and macrocrania in which bilateral huge acute and subacute postshunting subdural hematoma developed and remained asymptomatic. RESULTS: The first patient was treated initially by surgery. Subsequently, despite the persistence of the subdural collections, a nonsurgical policy was chosen. The second patient was deliberately nonsurgically treated. CONCLUSIONS: On the basis of our experience, we conclude that a nonsurgical policy should be followed in patients with long standing hydrocephalus and macrocrania, if they develop postshunting large hemorrhagic subdural collections and remain asymptomatic.
BACKGROUND: Subdural hematoma is a well-known complication of hydrocephalus shunting procedures. Since the advent of modern neuroimaging techniques, a more realistic incidence of subdural hematomas in shunted patients has been recognized. The description of several asymptomatic cases raises the problem of choosing the most appropriate therapeutic policy for such a condition. METHODS: We report two cases with long standing hydrocephalus and macrocrania in which bilateral huge acute and subacute postshunting subdural hematoma developed and remained asymptomatic. RESULTS: The first patient was treated initially by surgery. Subsequently, despite the persistence of the subdural collections, a nonsurgical policy was chosen. The second patient was deliberately nonsurgically treated. CONCLUSIONS: On the basis of our experience, we conclude that a nonsurgical policy should be followed in patients with long standing hydrocephalus and macrocrania, if they develop postshunting large hemorrhagic subdural collections and remain asymptomatic.