Document Detail


Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature.
MedLine Citation:
PMID:  16023537     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We report a complication of decompressive craniectomy in the treatment of aneurismal subarachnoid hemorrhage (SAH) and accompanying middle cerebral artery (MCA) infarction. A 56-year-old man presented with subarachnoid hemorrhage and right sylvian hematoma. He was diagnosed with high-grade SAH and medical therapy was employed. He showed rapid clinical deterioration on day 9 of his admission. Computed tomographic scans showed right MCA infarction and prominent midline shift. Because of the patient's rapidly worsening condition, further evaluation to find origin of SAH could not be obtained, and decompressive right hemicraniectomy was performed. During sylvian dissection, right middle cerebral and posterior communicant artery aneurysms were detected and clipped. One week after operation, a contralateral frontoparietal subdural effusion and left to right midline shift was detected and drained through a burr-hole. Through successive percutaneous aspirations, effusion recurred and complete resolution was achieved after cranioplasty and subduroperitoneal shunt procedures. Decompressive craniectomy is generally accepted as a technically simple operation with a low incidence of complications. In the light of this current case, we hypothesize that a large craniectomy may facilitate the accumulation of recurrent effusion on contralateral side creating a resistance gradient between two hemispheres. This point may be especially true for subarachnoid hemorrhage cases requiring aneurysm surgery. We conclusively suggest that subdural effusions may be resistant to simple drainage techniques if a large contralateral craniectomy does exist, and early cranioplasty may be required for treatment in addition to drainage procedures.
Authors:
Cumhur Kilincer; Osman Simsek; M Kemal Hamamcioglu; Tufan Hicdonmez; Sebahattin Cobanoglu
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Clinical neurology and neurosurgery     Volume:  107     ISSN:  0303-8467     ISO Abbreviation:  Clin Neurol Neurosurg     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-18     Completed Date:  2005-10-11     Revised Date:  2009-10-14    
Medline Journal Info:
Nlm Unique ID:  7502039     Medline TA:  Clin Neurol Neurosurg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  412-6     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Trakya University Medical Faculty, Edirne, Turkey. ckilincer@medscape.com
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MeSH Terms
Descriptor/Qualifier:
Craniotomy / adverse effects*
Decompression, Surgical / adverse effects*
Humans
Infarction, Middle Cerebral Artery / surgery*
Male
Middle Aged
Subarachnoid Hemorrhage / surgery*
Subdural Effusion / etiology*,  pathology,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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