1
|
Lane JR, Ssentongo P, Peterson MR, Harper JR, Mbabazi-Kabachelor E, Mugamba J, Ssenyonga P, Onen J, Donnelly R, Levenbach J, Cherukuri V, Monga V, Kulkarni AV, Warf BC, Schiff SJ. Preoperative risk and postoperative outcome from subdural fluid collections in African infants with postinfectious hydrocephalus. J Neurosurg Pediatr 2022; 29:31-39. [PMID: 34598146 PMCID: PMC9078082 DOI: 10.3171/2021.7.peds21209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study investigated the incidence of postoperative subdural collections in a cohort of African infants with postinfectious hydrocephalus. The authors sought to identify preoperative factors associated with increased risk of development of subdural collections and to characterize associations between subdural collections and postoperative outcomes. METHODS The study was a post hoc analysis of a randomized controlled trial at a single center in Mbale, Uganda, involving infants (age < 180 days) with postinfectious hydrocephalus randomized to receive either an endoscopic third ventriculostomy plus choroid plexus cauterization or a ventriculoperitoneal shunt. Patients underwent assessment with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III; sometimes referred to as BSID-III) and CT scans preoperatively and then at 6, 12, and 24 months postoperatively. Volumes of brain, CSF, and subdural fluid were calculated, and z-scores from the median were determined from normative curves for CSF accumulation and brain growth. Linear and logistic regression models were used to characterize the association between preoperative CSF volume and the postoperative presence and size of subdural collection 6 and 12 months after surgery. Linear regression and smoothing spline ANOVA were used to describe the relationship between subdural fluid volume and cognitive scores. Causal mediation analysis distinguished between the direct and indirect effects of the presence of a subdural collection on cognitive scores. RESULTS Subdural collections were more common in shunt-treated patients and those with larger preoperative CSF volumes. Subdural fluid volumes were linearly related to preoperative CSF volumes. In terms of outcomes, the Bayley-III cognitive score was linearly related to subdural fluid volume. The distribution of cognitive scores was significantly different for patients with and those without subdural collections from 11 to 24 months of age. The presence of a subdural collection was associated with lower cognitive scores and smaller brain volume 12 months after surgery. Causal mediation analysis demonstrated evidence supporting both a direct (76%) and indirect (24%) effect (through brain volume) of subdural collections on cognitive scores. CONCLUSIONS Larger preoperative CSF volume and shunt surgery were found to be risk factors for postoperative subdural collection. The size and presence of a subdural collection were negatively associated with cognitive outcomes and brain volume 12 months after surgery. These results have suggested that preoperative CSF volumes could be used for risk stratification for treatment decision-making and that future clinical trials of alternative shunt technologies to reduce overdrainage should be considered.
Collapse
Affiliation(s)
- Jessica R. Lane
- Department of Neurosurgery, Penn State College of Medicine, Hershey
| | - Paddy Ssentongo
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park,Department of Public Health Sciences, Penn State College of Medicine, Hershey
| | - Mallory R. Peterson
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park
| | - Joshua R. Harper
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park
| | | | | | - Peter Ssenyonga
- CURE Children’s Hospital of Uganda, Mbale,Mulago National Referral Hospital, Kampala, Uganda
| | - Justin Onen
- CURE Children’s Hospital of Uganda, Mbale,Mulago National Referral Hospital, Kampala, Uganda
| | - Ruth Donnelly
- Division of Neurosurgery, University of Toronto, Hospital for Sick Children, Toronto
| | - Jody Levenbach
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Venkateswararao Cherukuri
- School of Electrical Engineering and Computer Science, The Pennsylvania State University, University Park
| | - Vishal Monga
- School of Electrical Engineering and Computer Science, The Pennsylvania State University, University Park
| | - Abhaya V. Kulkarni
- Division of Neurosurgery, University of Toronto, Hospital for Sick Children, Toronto
| | - Benjamin C. Warf
- Department of Neurosurgery, Boston Children’s Hospital and Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Steven J. Schiff
- Department of Neurosurgery, Penn State College of Medicine, Hershey,Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park,Department of Physics, The Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
2
|
Armored brain in a young girl with a syndromal hydrocephalus. Acta Neurochir (Wien) 2017; 159:81-83. [PMID: 27778104 PMCID: PMC5177664 DOI: 10.1007/s00701-016-2991-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/05/2016] [Indexed: 11/03/2022]
Abstract
The authors present a case of a young girl affected by a syndromal hydrocephalus who developed a bilateral ossified chronic subdural hematoma with the typical radiological appearance of "the armored brain". Bilateral calcified chronic subdural hematoma is a rare complication of ventriculoperitoneal shunt. There is controversy in the treatment, but most published literature discourages a surgical intervention to remove the calcifications.
Collapse
|
3
|
Clinical Analysis of Subdural Hematoma after Ventriculoperitoneal Shunt for Hydrocephalus. Korean J Neurotrauma 2012. [DOI: 10.13004/kjnt.2012.8.2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
4
|
Murata T, Shigeta H, Horiuchi T, Sakai K, Hongo K. Globular subdural hematoma in a shunt-treated infant: case report. J Neurosurg Pediatr 2010; 5:210-2. [PMID: 20121374 DOI: 10.3171/2009.9.peds09391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Subdural hematoma (SDH) is a well-known sequela of ventriculoperitoneal shunt insertion for hydrocephalus, usually spreads out over the cerebral convexity, and appears as a crescent-shaped lesion on imaging. The authors report the rare case of an infant with a globular SDH, which MR imaging revealed as a round mass lesion. A 13-month-old girl with a history of severe congenital hydrocephalus associated with myeloschisis underwent ventriculoperitoneal shunt placement after repair of myeloschisis and developed convulsive seizure. Magnetic resonance imaging showed a large subdural round mass with a lesion like a pedestal in the left parietal region, suggesting a globular SDH surrounded by a thin cerebral mantle. Because of the seizures and because the hematoma did not respond to a change in valve pressure, the patient underwent a craniotomy to remove the hematoma and to resect the thick outer membranes of multiple layers. Postoperative MR imaging demonstrated the disappearance of the SDH, and no additional shunt complication was observed during a long follow-up period. To the authors' knowledge, this is the first report of a patient with globular SDH published in the literature. The authors postulate that the globular SDH was caused by the thin cerebral mantle associated with severe craniocerebral disproportion, and they discuss the possible mechanisms for this unique formation.
Collapse
Affiliation(s)
- Takahiro Murata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | | | | | | | | |
Collapse
|
5
|
Kitagawa M, Kanayama K, Sakai T. Subdural accumulation of fluid in a dog after the insertion of a ventriculoperitoneal shunt. Vet Rec 2005; 156:206-8. [PMID: 15747657 DOI: 10.1136/vr.156.7.206] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A dog with hydrocephalus as a result of aqueduct stenosis and cerebellar herniation underwent ventriculoperitoneal shunting. Magnetic resonance images and computed tomography scans taken after the surgery revealed subdural accumulations of haemorrhagic fluid and cereberocortical collapse caused by overshunting and leakage of cerebrospinal fluid from the site of insertion of the shunt. However, the degree of cerebellar herniation was reduced after the shunt was inserted, and the dog did not develop any neurological signs and made good progress.
Collapse
Affiliation(s)
- M Kitagawa
- Department of Preventive Veterinary Medicine and Animal Health, Nihon University School of Veterinary Medicine, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | | | | |
Collapse
|
6
|
Gelabert-González M, Fernández-Villa JM, López-García E, García-Allut A. [Chronic subdural hematoma in patients over 80 years of age]. Neurocirugia (Astur) 2001; 12:325-30. [PMID: 11706677 DOI: 10.1016/s1130-1473(01)70689-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chronic subdural hematoma (CSH) represents one of the most frequent types of intracranial hemorrhage. Most occur in elderly patients causing a variety of therapeutic problems associated to systemic diseases. PATIENTS AND METHODS A retrospective study of 90 patients older than 80 years of age with chronic subdural hematoma treated in the last 15 years was undertaken. For clinical evaluation on admission and at discharge we used the classification of Markwalder. Surgical treatment was performed in all patients and a burr hole craniostomy with closed drainage system was used. RESULTS On admission, 73 patients (80%) were in satisfactory condition (grades 0-2); 17 (20%) were grade 3 or 4. Seven (7.7%) patients died but none due to surgery. In 6 (6.6%) of the patients, surgical reintervention was required to remove a recurring CSH. In 76.6% of the patients, the results achieved were graded 0 or 1. CONCLUSIONS In our experience CSH in elderly patients should be treated with minimal surgery with a simple drainage of the subdural space. The good results suggest that the procedure could be considered as a first procedure in these patients and that age or concomitant diseases do not appear to be poor prognostic factors.
Collapse
Affiliation(s)
- M Gelabert-González
- Servicio de Neurocirugía, Hospital Clínico de Santiago, Departamento de Cirugía, Universidad de Santiago de Compostela
| | | | | | | |
Collapse
|