Epidural Hygroma Research Articles

A Clinical Experience with Decompressive Craniectomy.

To investigate the patients who underwent decompressive craniectomy (DC) for trauma or cerebrovascular disease, and to determine the most suitable treatment protocol for those patients. Overall, 32 patients with trauma or cerebrovascular disease underwent DC. Clinical, radiological and surgical data of surviving patients was retrospectively analysed. The occurence of favourable and unfavourable outcomes during the course of their treatment were recorded. We detected ventriculomegaly in nine out of the 32 patients (9/32, 28.1%) after DC. Of these nine, four patients (4/9, 44.4%) underwent shunt surgery. Cranioplasty performed in 29 of the 32 patients caused epidural hygroma in 13 of them (13/29, 44.8%). Of these 13 patients, three underwent surgery because of progressive increase in the size of hygromas. In the remaining patients, the epidural hygromas regressed spontaneously. Glasgow coma score (GCS) before and after DC surgery (p=0.011 and p=0.006, respectively), timing of cranioplasty (p=0.028), midline shift (p=0.048) and craniectomy size (p=0.047) were significantly associated with ventriculomegaly. Lower GCS, delayed cranioplasty, greater midline shift and larger craniectomy size were found to be associated with hydrocephalus after DC. To avoid hydrocephalus, it may be beneficial to perform shunt surgery first followed by cranioplasty in a single surgical procedure. Additionally, epidural hygromas frequently encountered after a cranioplasty that should be considered and followed up carefully.

Cerebral Hernia Caused By Epidural Hygroma Due to Excessive Drainage of Cerebrospinal Fluid: A Rare Case and Literature Review

The cerebral hernia is usually caused by intracranial hematoma, tumor, abscess. Here, we report a rare case of cerebral hernia caused by severe epidural hygroma. The patient was a 51-year-old male, with a large, right-sided skull defect and severe scalp depression, who had received a decompressive craniectomy for traumatic brain injury and a lumboperitoneal shunt for secondary hydrocephalus 6 months earlier. A cranioplasty with titanium mesh was performed after admitted. Unfortunately, he suffered from a complication of epidural fluid collection. Through repeated local treatment of the hygroma, the patient was not better but rather became more and more serious, and developed to cerebral hernia eventually. However, after finding out the root cause, the patient got dramatically improvement just by elevating the valve pressure of the lumboperitoneal shunt. The case and literature review are instructive to the treatment of patients with skull bone defect associated with hydrocephalus.

Delayed Posttraumatic Unilateral Occipital Epidural Hygroma in Early Childhood

An extremely rare case of posttraumatic epidural hygroma in the left occipital supratentorial and infratentorial region is reported. A year and five months old child was admitted to the Clinic of Neurosurgery with sustained occipital head injury. She presented with drowsiness and vomiting due to intracranial hypertension. Initial computed tomography scan revealed left-sided fracture of the squamous part of the occipital bone without associated traumatic changes to the brain. A second spiral computed tomography scan was obtained two days later because of persisting symptoms of increased intracranial pressure. It demonstrated a newly formed left-sided epidural hygroma adjacent to the skull fracture in the left supratentorial and infratentorial occipital region. The case is discussed with emphasis on the mechanism of formation of epidural hygroma and an attempt has been made to outline the major predisposing factors leading to the development of this traumatic disease. Necessity for computed tomography follow-up is pointed out in order to diagnose delayed posttraumatic hygromas. The recommended surgical approach should include craniotomy centered at the site of the epidural hygroma and obligatory dural elevation by means of traction sutures to eliminate the posttraumatic epidural cavity.

A new instrument facilitates the needle trephination procedure: technical note.

Percutaneous needle trephination is a well known neurosurgical procedure. The aim of this study was to develop a new instrument, which allows a stable fixation of an 18-G spinal needle in order to improve handling and precision of percutaneous needle trephinations. METHODS AND INSTRUMENTATION: The needle stabilizer was designed in a T-shape fashion morphologically similar to a corkscrew. The length of the uncovered needle tip is adjustable for individual requirements. Using the new needle stabilizing device a total number of 18 percutaneous needle trephinations were performed for the following indications: subdural hematoma, epidural hygroma, bifrontal air accumulation, superficial tumor cyst, superficial brain abscess. No complications have been observed. Our experience using this device shows that the modified technique fulfils criteria for clinical acceptance such as simplicity, low risk, reliability and cost effectiveness.

Posttraumatic epidural hygroma with associated subdural spinal fluid collection. Case report

We report a head-injured patient in whom CT scan revealed an extracerebral hypodense fluid collection separated into two compartments by a membrane, which was probably the torn dura mater. We briefly discuss the probable pathogenetic mechanism.