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Background Contralateral subdural effusion (SDE) is usually considered as an uncommon complication after decompressive craniectomy (DC) for head trauma. This complication may need more aggressive treatment because of its tendency to cause midline shift and neurologic deterioration. In this article, we present our experience with this group of patients and discuss the diagnosis and management of this entity. Methods This study included 13 patients with severe traumatic brain injury who developed contralateral SDE after DC. Clinical and radiographic information was obtained through a retrospective review of the medical records and the radiographs. Results The average time from the procedure of DC to the diagnosis of contralateral SDE was 13 days. Deterioration of clinical condition or appearance of new symptoms/signs related to the contralateral SDE was noted in four patients. In the remaining nine patients without apparent clinical deterioration, the contralateral SDE was discovered on routine computed tomography scan. Six patients were treated conservatively and the contralateral SDE resolved gradually. In six patients who underwent burr hole craniectomy to evacuate the SDE, the operation had successfully drained the SDE in four patients. Two patients received subsequent subduroperitoneal shunt to manage the reaccumulation of SDE. In one patient, subduroperitoneal shunt and cranioplasty were performed simultaneously to treat the SDE. Subsequently, six patients (46.2%) developed hydrocephalus and underwent ventriculoperitoneal shunt operation. Conclusions Contralateral SDE may not be a rare complication after DC. Its diagnosis may be delayed or missed when it is asymptomatic or the clinical condition of the patient masks its clinical manifestations. It may be reasonable to repeat a computed tomography scan to detect contralateral SDE 2 weeks to 3 weeks after DC, irrespective of the clinical condition. In addition, posttraumatic hydrocephalus is a common late consequence in these patients. Close surveillance in these patients is indicated to prompt appropriate management.

Artificial dural substitutes are increasingly being used in decompressive craniectomy to prevent peridural fibrosis and facilitate cranioplasty for patients with head injury. The safety of the dural substitute should be systemically evaluated. We focus on Neuro-Patch (B. Braun, Boulogne, France), a nonabsorbable substitute and commonly used by neurosurgeons.In this retrospective study, 132 patients undergoing 135 craniectomies and cranioplasties for traumatic brain injury were enrolled. We subdivided the operations into two groups on the basis of whether Neuro-Patch was used (N = 50) or not (N = 85). Risk factors of neurosurgical site infection were assessed first. Then, we compared the occurrence of infective, hemorrhagic, and hydrodynamic morbidities after craniectomy and cranioplasty between the two groups.The incidence of neurosurgical site infection after craniectomy or cranioplasty showed no intergroup difference (p = 1.000). Postoperatively, extra-axial hematoma, which consists of subdural or epidural hematoma, occurred in 9 of 50 craniectomies (18.00%) with Neuro-Patch and 3 of 85 craniectomies (3.53%) without Neuro-patch, which was significantly different (p = 0.009). The rates of hydrodynamic morbidities (subdural hygroma or cerebrospinal fluid leakage) after the procedures were similar between the two groups.The use of Neuro-Patch does not increase the incidence of neurosurgical site infection and hydrodynamic complications, including subdural hygroma and cerebrospinal fluid leakage, after decompressive craniectomy or cranioplasty for severe traumatic brain injury. However, extra-axial hematoma at the site of craniectomy is more often encountered in patients with Neuro-Patch and forms a compressive lesion on the adjacent brain.

Cervical spinal cord injury (SCI) is a devastating event for the patient and family. It has a huge impact on society because of the intensive resources required to manage the patient in both the acute and rehabilitation phases. There is a need for better delineation of potential prognostic factors and outcomes in patients with acute cervical SCI.In this 5-year retrospective study, 75 adult patients diagnosed with acute nonfracture and nondislocation cervical SCI were enrolled into this study. Cervical X-ray and magnetic resonance imaging were available for all patients at admission and discharge. Epidemiologic data, management, complications, neurologic status, and change were assessed. Neurologic recovery from acute cervical SCI was determined by changes in the Japanese Orthopaedic Association score.Thirty-eight patients had surgical intervention, accounting for 50.67% (38 of 75) of the episodes. The Japanese Orthopaedic Association outcome score between the two groups, with or without surgical intervention, was statistically significant (p = 0.035). Statistical analysis of the clinical manifestations and neurologic images of the two patient groups revealed the following significant findings: limb weakness (p = 0.025) and days of hospitalization (p = 0.039).The treatment of acute nonfracture and nondislocation cervical SCI is still controversial and presents therapeutic challenges. A careful neurologic examination and high-resolution magnetic resonance imaging evaluation are necessary to determine whether surgical intervention is indicated. According to our data, when patients present with acute limb weakness, surgical intervention is necessary to improve the outcome.