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    
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.
Cumhur Kilincer; Osman Simsek; M Kemal Hamamcioglu; Tufan Hicdonmez; Sebahattin Cobanoglu
Related Documents :
19005377 - Lower pretreatment cerebral blood volume affects hemorrhagic risks after intra-arterial...
2061477 - Bleeding patterns in ruptured posterior fossa aneurysms: a ct study.
16041467 - The risk of rebleeding after external lumbar drainage in patients with untreated ruptur...
23702737 - Morphology of the cerebral arterial circle in the prenatal and postnatal period of serb...
19499667 - Domino effect from hypertriglyceridemia to sinistral portal hypertension.
1732967 - Absence of the carotid canals at skull base ct.
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    
Department of Neurosurgery, Trakya University Medical Faculty, Edirne, Turkey.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Craniotomy / adverse effects*
Decompression, Surgical / adverse effects*
Infarction, Middle Cerebral Artery / surgery*
Middle Aged
Subarachnoid Hemorrhage / surgery*
Subdural Effusion / etiology*,  pathology,  surgery

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

Previous Document:  Intracranial hypertension as an initial manifestation of spinal neuroectodermal tumor.
Next Document:  Anaplastic oligodendroglioma presenting with drop metastases in the cauda equina.