Faculty Collaboration Database

Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants-a preliminary single-institution experience. J Neurosurg Pediatr 2011 Nov;8(5):423-9

Date

11/03/2011

Pubmed ID

22044363

DOI

10.3171/2011.8.PEDS1131

Scopus ID

2-s2.0-80655145852 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECT: Various surgical interventions have been described to evacuate chronic subdural collections (CSCs) of infancy. These include transfontanel percutaneous aspiration, subdural drains, placement of bur hole(s) with or without a subdural drain, and shunting. Shunt placement typically provides good long-term success (resolution of the subdural fluid), but comes with well-known early and late complications. Recently, the authors have used a mini-osteoplastic craniotomy technique with the goal of definitively treating these children with a single surgery while avoiding the many issues associated with a shunt. They describe their procedure and compare it with the traditional bur hole technique.

METHODS: In this single-institution retrospective study, the authors evaluated 26 cases involving patients who underwent treatment for CSC. Preoperative, intraoperative, and postoperative data were reviewed, including radiographic findings (density of the subdural fluid and ventricular and subarachnoid space size), neurological examination findings, and intraoperative fluid description. The primary outcome was treatment failure, defined as the patient requiring any subsequent surgical intervention after the index procedure (minicraniotomy or bur hole placement).

RESULTS: Fifteen patients (10 male and 5 female; median age 5.1 months) collectively underwent 27 minicraniotomy procedures (each procedure representing a hemisphere that was treated). In the bur hole group, there were 11 patients (6 male and 5 female; median age 4.6 months) with 18 hemispheres treated. Both groups had subdural drains placed. The average follow-up for each treatment group was just over 7 months. Treatment failure occurred in 2 patients (13%) in the minicraniotomy group compared with 5 patients (45%) in the bur hole group (p = 0.09). Furthermore, the 2 patients who had treatment failure in the minicraniotomy group required 1 subsequent surgery each, whereas the 5 in the bur hole group needed a total of 9 subsequent surgeries. Eventually, 80% of the patients in the minicraniotomy group and 70% of those in the bur hole group had resolution of the subdural collections on the last imaging study.

CONCLUSIONS: The minicraniotomy technique may be a superior technique for the treatment of CSCs in infants compared with bur hole evacuation. The minicraniotomy provides greater visualization of the subdural space and allows more aggressive evacuation of the fluid, better irrigation of the space, the ability to fenestrate any accessible membranes safely, and continued egress of fluid into the subgaleal space. Although this preliminary report has obvious limitations, evaluation of this technique may be worthy of a prospective, multiinstitutional collaborative effort.

Author List

Klimo P Jr, Matthews A, Lew SM, Zwienenberg-Lee M, Kaufman BA

Authors

Bruce A. Kaufman MD Adjunct Professor in the Neurosurgery department at Medical College of Wisconsin
Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin
Anne E. Matthews PAC APP Hybrid in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Craniotomy
Drainage
Female
Head
Hematoma, Subdural, Chronic
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging
Male
Microsurgery
Postoperative Care
Retrospective Studies
Secondary Prevention
Subdural Effusion
Subdural Space
Tomography, X-Ray Computed
Treatment Outcome