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Objective: The primary aim of this research is to investigate the predictive value of subdural effusion thickness in determining the progression of post-traumatic subdural effusion to chronic subdural hematoma. Studying this progression is crucial as it helps in early diagnosis and effective management of chronic subdural hematoma, which is a serious and life-threatening condition. This research is valuable and relevant for improving patient outcomes and reducing the associated risks and complications., Methods: We conducted a retrospective examination of the clinical data obtained from 124 patients who were treated for post-traumatic subdural effusion at our neurosurgery department between March 2017 and March 2021. The data collection process involved reviewing the patients' medical records, radiographic images, and follow-up visits. We used strict criteria for patient selection, including a confirmed diagnosis of post-traumatic subdural effusion, availability of follow-up data, and no prior history of chronic subdural hematoma. Patients who experienced a progression of subdural effusion to chronic subdural hematoma were assigned to the hematoma group (26 cases). In comparison, those who did not show such progression were categorized into the effusion group (98 cases). We endeavored to identify potential risk factors contributing to the progression from subdural effusion to chronic subdural hematoma. The predictive strengths of these risk factors were evaluated using receiver operating characteristic (ROC) curves., Results: There were no statistically significant disparities between the two groups in terms of gender, hypertension, COPD, and GCS scores (P > .05). However, significant differences were noted in the variables of age, tSAH, the location of subdural effusion, and subdural effusion thickness (P < .05). Multivariate logistic regression analysis disclosed age (1.213), tSAH (12.542), and subdural effusion thickness (1.786) as independent risk factors for the conversion of TSE to CSDH (P < .05). The ROC curve showed the AUC values of age, tSAH, and subdural effusion thickness for predicting CSDH to be 0.739, 0.670, and 0.820, respectively, with a combined AUC value of 0.942, thereby outperforming the individual tests., Conclusion: In patients suffering from post-traumatic subdural effusion, the thickness of the subdural effusion emerges as a strong predictor for its progression into a chronic subdural hematoma. Clinicians should be particularly cautious when the effusion thickness exceeds 10.7 mm, as the likelihood of transformation increases significantly. These findings have important implications for clinical practice and patient management, highlighting the need for prompt and effective treatment to prevent chronic complications.

Case: We present the case of a 59-year-old man who had MIS L4-5 decompression. He presented the next day with intractable back and leg pain. Magnetic resonance imaging revealed ventral displacement of the cauda equina and a subdural collection on the right L3/L4 nerve roots. Revision decompression revealed occult durotomy caudal and contralateral to the index decompression., Conclusion: Minimally invasive spine (MIS) surgery leverages shorter operative time and reduced postoperative pain. Yet, decreased exposure can make identification and management complications challenging. This report highlights occult durotomy and spinal subdural extra-arachnoid hygroma in patients with postoperative nerve compression after seemingly uncomplicated MISS., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C366)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

A 2.5-year-old spayed female Chihuahua dog was presented with chronic cervical pain and exhibited a "prayer-like position" following a history of a 4-meter fall. CT and MRI revealed a moderate right-sided enlargement of the subdural space with cerebrospinal fluid, consistent with a subdural hygroma, appearing connected to a quadrigeminal cistern dilation. Percutaneous transfontanellar external drainage of the subdural fluid accumulation did not prevent its re-accumulation, and the dog was managed medically, leading to the complete resolution of clinical signs. The subdural hygroma was suspected to be secondary to the previous trauma., (© 2024 American College of Veterinary Radiology.)

Introduction: Bone flap replacement after a decompressive craniectomy is a low complexity procedure, but with complications that can negatively impact the patient's outcome. A better knowledge of the risk factors for these complications could reduce their incidence., Patients and Methods: A retrospective review of a series of 50 patients who underwent bone replacement after decompressive craniectomy at a tertiary center over a 10-year period was performed. Those clinical variables related to complications after replacement were recorded and their risk factors were analyzed., Results: A total of 18 patients (36%) presented complications after bone flap replacement, of which 10 (55.5%) required a new surgery for their treatment. Most of the replacements (95%) were performed in the first 90 days after the craniectomy, with a tendency to present more complications compared to the subsequent period (37.8% vs 20%, p > 0.05). The most frequent complication was subdural hygroma, which appeared later than infection, the second most frequent complication. The need for ventricular drainage or tracheostomy and the mean time on mechanical ventilation, ICU admission, or waiting until bone replacement were greater in patients who presented post-replacement complications. Previous infections outside the nervous system or the surgical wound was the only risk factor for post-bone flap replacement complications (p = 0.031)., Conclusions: Postoperative complications were recorded in more than a third of the patients who underwent cranial bone flap replacement, and at least half of them required a new surgery. A specific protocol aimed at controlling previous infections could reduce the risk of complications and help establish the optimal time for cranial bone flap replacement., (Copyright © 2024 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.)

Persistent hydrocephalus is common in children after resection of posterior fossa tumours. However, occurrence of subdural hygroma is very rare. We report the case of a 14-month-old child who presented at a paediatric neurology clinic in Muscat, Oman in 2021 who developed a tense subdural hygroma with stable hydrocephalus, in the early postoperative period, following posterior fossa tumour resection. We describe the distinctive clinical, radiological and pathological features associated with the development of a tense subdural hygroma. We also discuss the management by cerebrospinal fluid diversion, which includes either a ventriculoperitoneal or subduroperitoneal shunt. This unique condition is distinguished from external hydrocephalus by features that are critical to the management strategy., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Case: A 73-year-old woman, after spinal surgery, presented with symptomatic spinal subdural extra-arachnoid hygroma (SSEH) because of a fall on the third postoperative day. The hygroma was diagnosed by magnetic resonance imaging (MRI). Lumbar puncture was performed under local anesthesia, after which the leg pain disappeared immediately. MRI obtained immediately after puncture and 1 week later confirmed disappearance of the hygroma., Conclusion: Although dural transection is mentioned in most of the reports on treatment of symptomatic postoperative SSEH, we were able to treat this entity by epidural puncture. In the absence of paraplegia or cystorectal disturbance, puncture can be an effective and minimally invasive treatment option., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C252)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Objective: To evaluate the incidence, associated factors, clinical course, and management options of subdural hygroma in patients treated for aneurysmal subarachnoid hemorrhage (aSAH)., Methods: From January 2013 until June 2022, 336 consecutive patients with aSAH underwent treatment in our center. No one patient was excluded from the study cohort. Computed tomography (CT) examinations were performed at admission, immediately after surgery and on the first postoperative day, and subsequently in case of any neurologic deterioration or, at least, once per week until discharge from the hospital. Thereafter, CT examinations were at the discretion of specialists in the rehabilitation facility, referring physicians, or neurosurgeons at the outpatient clinic., Results: The length of radiologic follow-up starting from CT at admission ranged from 1 to 3286 days (mean, 673 ± 895 days; median, 150 days). Subdural hygromas developed in 84 patients (25%). An average interval until this imaging finding from the initial CT examination was 25 ± 55 days (median, 8 days; range, 0-362 days). Evaluation in the multivariate model showed that patient age ≥72 years (P < 0.0001), cerebrospinal fluid (CSF) shunting (P < 0.0001), and microsurgical clipping of ruptured intracranial aneurysm (RIA; P < 0.0001) are independently associated with the development of subdural hygroma. In 54 of 84 cases (64%), subdural hygromas required observation only. Increase of the lesion size with (5 cases) or without (10 cases) appearance of midline shift was associated with patient age <72 years (P = 0.0398), decompressive craniotomy (P = 0.0192), and CSF shunting (P = 0.0009), whereas evaluation of these factors in the multivariate model confirmed independent association of only CSF shunting (P = 0.0003). Active management of subdural hygromas included adjustment of the shunt programmable valve opening pressure, cranioplasty, external subdural drainage, or their combination. Overall, during follow-up (mean, 531 ± 824 days; median, 119 days; range, 2-3285 days) after the start of observation or applied treatment, subdural hygromas showed either decrease (50 cases) or stabilization (34 cases) of their sizes, and no one lesion showed progression again., Conclusions: The clinical course of subdural hygromas in patients treated for aSAH is generally favorable, but occasionally these lesions show progressive enlargement with or without the appearance of midline shift, which requires active management., (Copyright © 2023. Published by Elsevier Inc.)

Competing Interests: Competing interests: None declared.

Background: Severe macrocephaly can still be found in developing countries. This condition is usually caused by neglected hydrocephalus and can cause a lot of morbidities. Cranial vault reconstruction cranioplasty is the main treatment option for severe macrocephaly. Holoprosencephaly is often seen with features of microcephaly. Hydrocephalus should be considered as the main cause in HPE patients with features of macrocephaly. In this report, we present a rare case of cranial vault reduction cranioplasty procedure in patient with severe macrocephaly due to holoprosencephaly and subdural hygroma., Case Description: A 4-year-10-month-old Indonesian boy was admitted with head enlargement since birth. He had a history of VP shunt placement when he was 3 months old. But the condition was neglected. Preoperative head CT showed massive bilateral subdural hygroma that compressed brain parenchyma caudally. From the craniometric calculation, the occipital frontal circumference was 70.5 cm with prominent vertex expansion, the distance between nasion to inion was 11.91 cm and the vertical height was 25.59 cm. The preoperative cranial volume was 24.611 cc. The patient underwent subdural hygroma evacuation and cranial vault reduction cranioplasty. The postoperative cranial volume was 10.468 cc., Conclusion: Subdural hygroma can be a rare cause of severe macrocephaly in holoprosencephaly patients. Cranial vault reduction cranioplasty and subdural hygroma evacuation is still the main treatment option. Our procedure successfully reduces significant cranial volume (57.46% volume reduction)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Spinal fusion surgery is the most commonly performed orthopaedic surgical procedure. However, subdural hygroma occurrence is a very rare complication after revision spinal fusion surgery. Here, we report a case of revision lumbar fusion surgery at the L3-4 level. The patient developed acute conus medullaris syndrome at 10 days postoperatively. MRI showed a subdural, extra-arachnoid area fluid collection following the T12-L2, cephalad to the area of revision spinal fusion. When patients have a decreased motor grade, difficulty in voiding urine and neurological abnormalities after lumbar spine surgery, conus medullaris syndrome with a possible occurrence of subdural hygroma should be considered. In this situation, immediate imaging investigations and emergency surgery might be necessary to reduce the pressure on the spinal cord., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Recently, a relationship between traumatic subdural hygroma (SDG) and chronic subdural hematoma (CSDH) has been proposed. However, the role of traumatic SDG in development of CSDH has not been well characterized. This systematic review aimed to estimate the rate of evolution of traumatic SDG to CSDH, and to identify risk factors associated with traumatic SDG evolution to CSDH. We searched MEDLINE, EMBASE, and Cochrane Library databases from inception to May 26, 2021, using the combination of the terms "subdural hygroma" and "chronic subdural hematoma." Using a random-effects model, we calculated a pooled estimate of rate of evolution of traumatic SDG to CSDH. In addition, we conducted a systematic review of studies of risk factors for traumatic SDG evolution to CSDH. Nineteen studies with 1,335 patients met the inclusion criteria for meta-analysis. The pooled estimate of evolution rate was 25.0 % (95 % CI, 19.3 %-30.7 %; I 2  = 85.6 %), with significant heterogeneity among studies (P < 0.01). Age ≥ 60 years was associated independently with traumatic SDG evolution to CSDH, after adjustment for study design using multivariate meta-regression. Risk factors associated with evolution of traumatic SDG to CSDH were radiological characteristics such as thicker SDG and higher SDG CT value. The rate of traumatic SDGs evolution to CSDH is approximately 25 %. Patients aged 60 or older with traumatic SDGs are at increased risk of CSDH development. Thicker SDG and higher SDG CT value, are commonly reported risk factors for traumatic SDG evolution to CSDH. However, higher quality studies are needed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background:  We present the case of an intracranial subdural hygroma resulting from intraoperatively undetected dural tear after unilateral biportal endoscopic (UBE) spine surgery for lumbar spinal stenosis., Case Description:  An 80-year-old woman presented with insidious onset, gradually progressing low back pain, and right leg pain of 1-year duration. The pain radiated to the right L4-L5 dermatomes. Neurogenic intermittent claudication was <300 m. Motor function was normal. Lumbar magnetic resonance imaging showed a lateral recess stenosis at the L3-L4 and L4-L5 levels. These lesions were operated on by the UBE decompression technique.No major complications were encountered during the operation. But soon we found out that there was an undiscovered dura tear. We placed the patient under close observation for 2 weeks. After 30 days, we confirmed that subdural hygroma had changed to chronic subdural hematoma. Conservative treatment was continued. On postoperative day 90), the condition was stable and the symptoms improved completely., Conclusions:  We concluded that a spinal cerebrospinal fluid leakage can result in an intracranial subdural hygroma. Intracranial subdural hygromas and hematomas after lumbar spinal surgery should be cautiously assessed and treated., Competing Interests: None declared, (Thieme. All rights reserved.)

Background: Campylobacter jejuni is a common cause of acute gastroenteritis, but central nervous system infections are rare manifestations of Campylobacter infection. Therefore, C. jejuni trauma-related subdural hygroma infection in children is poorly described in the literature., Case Presentation: We described a 2-year old boy with lobar holoprosencephaly presenting with subdural hygroma following head trauma. C. jejuni infection was confirmed from a subdural hygroma sample by culture as well as by DNA sequencing of a broad range 16S rDNA PCR product. Cerebrospinal fluid from the ventriculoperitoneal shunt remained sterile. Combined neurosurgical and antimicrobial treatment led to complete recovery. Review of the literature showed that the most common manifestation of Campylobacter central nervous system infection is meningitis, mostly in neonates, and subdural hygroma infection was described for only one case., Conclusions: Subdural hygroma infection caused by C. jejuni is a rare clinical condition in children. Molecular methods represent an important tool for the detection of rare or unexpected pathogens. No standard recommendations for antimicrobial treatment of C. jejuni subdural space infection in children are available, but meropenem treatment combined with surgery seems to be an effective approach., (© 2022. The Author(s).)

Background: While both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors' best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma. This study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA's medical treatment., Conclusion: DKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study., (© 2021. The Author(s).)

Introduction: Middle fossa arachnoid cyst (MFAC) is one of the most common cranial cysts in children, and the various postoperative complications following cyst fenestration represent a major concern. We conducted a retrospective study in our department and performed a systematic review of the literature to identify the risk factors for complications., Methods: A retrospective survey was conducted in 38 patients with MFAC (<14 years) who underwent microscopic fenestration from January 2019 to December 2020. Postoperative complications, including postoperative hemorrhage/hematoma, subdural hygroma (SH), cranial nerve palsy, postoperative central nervous system infection, and cerebrospinal fluid (CSF) leak, were collected. A systematic PubMed search for cohort studies on surgically treated MFAC published after 1980 was performed. The postoperative complications in the included studies were illustrated., Results: The overall complication rate in our series was 7.9%, among whom, 9 patients (23.7%) developed postoperative SH, one of which required cyst-peritoneal shunting. Patients who developed SH were significantly younger (4.0 ± 1.8 vs. 6.3 ± 3.4 years, p = 0.012). Binary logistic analysis showed that a lower age could be a risk factor for developing SH (odds ratio: 0.738, p = 0.067). One patient developed a subdural hematoma. No cranial nerve palsy or CSF leak was observed. Eighteen studies were included in the systematic review, comprising 649 cases of MFAC. The most common complication was SH (4.9%), and the postoperative complication rates were similar between the microscopic and endoscopic techniques., Conclusion: The complication rate of MFAC fenestration is considerable. SH is the most common postoperative complication, and it mostly occurs in young children. Strict surgical indications should be applied for young children., (© 2022 S. Karger AG, Basel.)

Objective: Contralateral subdural effusion after decompressive craniectomy (CSEDC) is rare, and the optimal treatment is not determined. We present 11 cases of CSEDC and give an overview of the English literature pertaining to this disease., Methods: We searched the database at our institution and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows (single word or combination): "subdural hygroma"; "subdural effusion"; "decompressive craniectomy". Only patients with CSEDC and contained adequate clinical information pertinent to the analysis were included., Results: 11 cases of CSEDC were recorded at our institution. They comprised ten men and one woman with an average age of 41.9 years. All the 8 symptomatic patients underwent surgery and the CSEDC resolved gradually. 68 cases of CSEDC were found in the literature. Including ours, a total of 79 patients were analyzed. Conservative treatment was effective in the asymptomatic patients. 41.7% of the symptomatic CSEDC underwent burr hole drainage and successfully drained the CSEDC. However, 76% of them received subsequent surgery to manage the reaccumulation of CSEDC. 25% of the symptomatic patients underwent cranioplasty, while 13.3% of them received Ommaya drainage later because of CSEDC recurrence. 18.3% of the symptomatic patients underwent cranioplasty plus subduroperitoneal shunting, and all CSEDC resolved completely., Conclusions: Burr hole drainage appears to be only a temporary measure. Early cranioplasty should be performed for patients with CSEDC. CSF shunting procedures may be required for patients in whom CSEDC have not been solved or hydrocephalus manifest after cranioplasty., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Intracranial arachnoid cysts are common, cerebrospinal fluid-filled, innocent lesions that are usually detected incidentally on brain imaging. They may rupture and complicate due to subdural hematoma or hygroma after minor trauma. Authors present two cases of ruptured middle cranial fossa arachnoid cysts in adolescent (12-year-old and 15-year-old) Afghan boys presenting with subdural hygroma after minor trauma., Conclusion: Imaging work-up is necessary for symptomatic patients following minor head trauma as incidentally detected ruptured intracranial arachnoid cysts can be responsible for the symptoms., (© 2021. The Author(s).)

Objective: This study investigated the incidence of postoperative subdural collections in a cohort of African infants with postinfectious hydrocephalus. The authors sought to identify preoperative factors associated with increased risk of development of subdural collections and to characterize associations between subdural collections and postoperative outcomes., Methods: The study was a post hoc analysis of a randomized controlled trial at a single center in Mbale, Uganda, involving infants (age < 180 days) with postinfectious hydrocephalus randomized to receive either an endoscopic third ventriculostomy plus choroid plexus cauterization or a ventriculoperitoneal shunt. Patients underwent assessment with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III; sometimes referred to as BSID-III) and CT scans preoperatively and then at 6, 12, and 24 months postoperatively. Volumes of brain, CSF, and subdural fluid were calculated, and z-scores from the median were determined from normative curves for CSF accumulation and brain growth. Linear and logistic regression models were used to characterize the association between preoperative CSF volume and the postoperative presence and size of subdural collection 6 and 12 months after surgery. Linear regression and smoothing spline ANOVA were used to describe the relationship between subdural fluid volume and cognitive scores. Causal mediation analysis distinguished between the direct and indirect effects of the presence of a subdural collection on cognitive scores., Results: Subdural collections were more common in shunt-treated patients and those with larger preoperative CSF volumes. Subdural fluid volumes were linearly related to preoperative CSF volumes. In terms of outcomes, the Bayley-III cognitive score was linearly related to subdural fluid volume. The distribution of cognitive scores was significantly different for patients with and those without subdural collections from 11 to 24 months of age. The presence of a subdural collection was associated with lower cognitive scores and smaller brain volume 12 months after surgery. Causal mediation analysis demonstrated evidence supporting both a direct (76%) and indirect (24%) effect (through brain volume) of subdural collections on cognitive scores., Conclusions: Larger preoperative CSF volume and shunt surgery were found to be risk factors for postoperative subdural collection. The size and presence of a subdural collection were negatively associated with cognitive outcomes and brain volume 12 months after surgery. These results have suggested that preoperative CSF volumes could be used for risk stratification for treatment decision-making and that future clinical trials of alternative shunt technologies to reduce overdrainage should be considered.

Competing Interests: Competing interests: None declared.

Introduction: Arachnoid cysts are a common incidental finding on head imaging. While the natural history of these cysts in poorly described, hemorrhage with subdural hygroma formation is rare. We review the clinical course of a patient who developed a subdural hygroma following trauma., Case: The patient was a previously healthy 14-month-old male who presented to the Emergency Department with vomiting after a fall and was found to have esotropia without other focal neurological deficits and a CT scan consistent with a subdural cerebrospinal fluid collection with midline shift. The patient was treated conservatively and his symptoms resolved., Discussion: Arachnoid cyst rupture is a rare complication which can lead to increased intracranial pressure with devastating consequences. Clinical manifestation can be similar to that of other intracranial pathologies. Prompt diagnosis is required to avoid life-threatening symptoms., Conclusion: Arachnoid cyst rupture should be considered when evaluating patients with non-specific neurological symptoms following trauma.

Objectives: This study aimed to summarize the surgical strategies for subdural effusion secondary to decompressive craniectomy (SESDC) and discuss the applicable scenarios of effusion-peritoneal shunt (EP shunt)., Methods: A total of 53 consecutive patients with SESDC were screened out of 7569 cases. The SESDC was divided into five types, and the treatment methods of each type were analyzed and compared. According to the implementation strategy of cranioplasty (CP), patients were divided into CP-first and delayed-CP groups. The differences in surgical methods were compared between the two groups., Results: All patients with SESDC in this cohort had undergone cranioplasty. Subcutaneous puncture and aspiration (SPAA) proved ineffective. Only 2/30 patients in the CP-first group used EP shunt, while 6/19 patients in the delayed-CP group used EP shunt; the difference was statistically significant (P = 0.03). A significant difference was found in the use of EP shunt among type 1, type 2, and type 5 SESDC (χ 2 = 6.778, P = 0.034)., Conclusions: CP combined with other treatments could cure most SESDC. EP shunt should be used preferentially in some specific scenarios in which CP cannot be performed first, rather than as a backup measure that can only be used when other preceding treatments fail., (Copyright © 2021. Published by Elsevier B.V.)

Purpose: Surgical fenestration is widely accepted as a primary treatment for middle fossa arachnoid cysts (MFACs) in pediatric patients. However, postoperative subdural effusion and/or hydrocephalus always affect treatment outcomes. In this study, we presented our experience of treating MFACs with surgical fenestration in pediatric patients and analyzed the cases complicated by postoperative subdural effusion and/or hydrocephalus, to give insight into the clinical characteristics predisposing the complications., Methods: We retrospectively analyzed 21 pediatric cases with MFACs treated by surgical fenestration suffering postoperative subdural effusion and/or hydrocephalus in our department from November 2011 to April 2019. We reviewed the clinical characteristics and treatment outcomes., Results: A total of 21 patients, among a total of 53 pediatric patients with MFACs treated by surgical fenestration, developed subdural effusion and/or hydrocephalus postoperatively. The mean age at the time of the initial surgery was 49 months. A total of 75% (6/8) of the patients under 2 years old and 13.3% (6/45) of the older patient group sustaining postoperative subdural effusion and/or hydrocephalus required further surgeries, respectively (Fisher's exact test, p = 0.001). Notably, among the 21 cases with postoperative subdural effusion and/or hydrocephalus, all the 6 patients under 2 years old needed additional surgeries, while of the other 15 older patients, only 40% (6/15) needed further surgical interventions (Fisher's exact test, p = 0.019)., Conclusion: The immature CSF absorption in MFAC patients younger than 2 years old might predispose them to the relatively serious postoperative subdural effusion and/or hydrocephalus. For very young patients with giant MFACs, surgical fenestration might not be the best option.

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7-14 days after the procedure requires further investigation to exclude life-threatening intracranial complications., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Subdural effusion (SDE) is a common complication secondary to decompressive craniectomy (DC). This current case report describes a patient with contralateral SDE with a typical clinical course. Initially, he made a good recovery following a head trauma that caused a loss of consciousness and was treated with decompressive craniectomy. However, he only achieved temporary relief after each percutaneous fluid aspiration from an Ommaya reservoir implanted into the cavity of the SDE. He was eventually transferred to the authors' hospital where he underwent cranioplasty, which finally lead to the reduction and disappearance of his contralateral SDE. Unexpectedly, his clinical condition deteriorated again 2 weeks after the cranioplasty with symptoms of an uncontrolled bladder. A subsequent CT scan found the apparent expansion of the whole cerebral ventricular system, indicating symptomatic communicating hydrocephalus. He then underwent a ventriculoperitoneal shunt procedure, which resulted in a favourable outcome and he was discharged 2 weeks later. A review of the current literature identified only 14 cases of contralateral SDE that were cured by cranioplasty alone. The mechanism of contralateral SDE has been widely discussed. Although the exact mechanism of contralateral SDE and why cranioplasty is effective remain unclear, cranioplasty could be an alternative treatment option for contralateral SDE.

Purpose: Rupture of arachnoid cysts (AC) in the subdural space after trauma may cause a subacute/chronic subdural hematoma or a hygroma. Treatment of this complication still remains controversial, and no consensual strategy is to date clearly proposed. In this study, the authors evaluated the clinical and radiological evolution of patients treated by a subduro-peritoneal shunt for symptomatic subdural collections complicating ruptured AC., Methods: Medical records of the 10 patients treated at our institution between January 2005 and December 2018 for a subdural collection associated with an intracranial AC were reviewed. Subduro-peritoneal shunts consisted of low-pressure valves from 2005 to 2012 (6 cases) and medium-pressure valves after 2012 (4 cases)., Results: A benign head trauma was retrospectively found in the history of 8 patients. The mean time to diagnosis ranged from 15 days to 5 months. Symptoms resulted mainly from intracranial hypertension. Six patients had an ipsilateral hygroma to the AC, 2 patients had a bilateral hygroma predominantly to the AC side, and 2 patients presented an ipsilateral chronic subdural hematoma. Arachnoid cysts were classified as Galassi I in 5 cases and Galassi II in 5 cases. Patients with chronic subdural hematoma were given a medium-pressure valve. Patients with subdural hygroma received a low-pressure valve in 6 cases and a medium-pressure valve in 2 cases. There were no complications during surgical procedures. All patients were rapidly free of symptoms after surgery and were discharged from hospital 1 to 4 days postoperatively. The subdural collection completely disappeared in all cases. In the long term, only 2 patients with low-pressure valves underwent shunt removal without any consequences, while a second surgical procedure was necessary to treat recurrence of intracranial hypertension in the 4 remaining cases. All the medium-pressure valves were removed without problems. The size of the AC was reduced in 3 cases, remained stable in 4 cases, and increased in 3 cases. No patients experienced recurrence of subdural collection during follow-up., Conclusions: Medium-pressure subduro-peritoneal shunts should be considered as part of the arsenal of surgical strategy in symptomatic ruptured AC in the subdural space. The procedure is simple with a very low morbidity, and it allows rapid improvement of symptoms. Although the shunt is located in the subdural space, we strongly recommend avoiding devices which may create an overdrainage and expose the patient to shunt dependency such as low-pressure shunts.

A 78-year-old woman with bilateral fungal sinusitis, which resulted in right orbital apex syndrome, underwent endoscopic sinus surgery and optic nerve decompression. Two months after the operation, she complained of anxiety and insomnia. Head CT showed subdural hematoma-like effusion and burr hole drainage was conducted. The collected fluid was not hematoma, but bloody, xanthochromic effusion with no pathogenic bacteria. Ten days later, she underwent drainage and dural biopsy after craniotomy because of relapse of subdural hygroma and progression of hypertrophic pachymeningitis associated with aggravation of psychiatric symptoms. A sample of the dura mater showed dense fibrosis with thickening, and Pseudomonas aeruginosa (P. aeruginosa) was detected by culture. Although otitis or sinusitis secondary to P. aeruginosa infection has been reported as a leading cause of infectious pachymeningitis, psychiatric symptoms alone and concomitant refractory subdural hygroma are atypical and unreported manifestations. In patients with pachymeningitis and a history of transnasal endoscopic surgery, P. aeruginosa infection should be considered, irrespective of an atypical clinical course and negative blood or fluid culture. Additionally, dural biopsy might help in detection of pathogenic bacteria.

Subdural hygroma (SDG) represents a common complication following decompressive craniectomy (DC). To our knowledge we present the first meta-analysis investigating the role of clinical and technical factors in the development of SDG after DC for traumatic brain injury. We further investigated the impact of SDG on the final prognosis of patients. The systematic review of the literature was done according to the PRISMA guidelines. Two different online medical databases (PubMed/Medline and Scopus) were screened. Four articles were included in this meta-analysis. Data regarding age, sex, trauma dynamic, Glasgow Coma Scale (GCS), pupil reactivity and CT scan findings on admission were collected for meta-analysis in order to evaluate the possible role in the SDG formation. Moreover we studied the possible impact of SDG on the outcome by evaluating the rate of patients dead at final follow-up and the Glasgow Outcome Scale (GOS) at final follow-up. Among the factors available for meta-analysis only the basal cistern involvement on CT scan was associated with the development of a SDG after DC (p < 0.001). Moreover, patients without SDG had a statistically significant better outcome compared with patients who developed SDG after DC in terms of GOS (p < 0.001). The rate of patients dead at follow-up was lower in the group of patients without SDH (8.25%) compared with patients who developed SDG (11.51%). SDG after DC is a serious complication affecting the prognosis of patients. Further studies are needed to define the role of some adjustable technical aspect of DC in preventing such a complication., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Recent studies have examined hypertrophic pachymeningitis as an IgG4-RD. However, there are no reports of immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis with polycystic subdural hygroma., Case Presentation: A 56-year-old man presented to the hospital with complaints of a persistent, pulsatile, occipital headache and general malaise. Magnetic resonance imaging of the brain revealed hypertrophic pachymeningitis with polycystic subdural hygroma and hematoma. Based on the dural biopsy findings and exclusion of other diseases, the patient was diagnosed with immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis. IgG4-related diseases may cause subdural hygroma more commonly than other diseases that cause hypertrophic pachymeningitis., Conclusions: This is the first case report discussing polycystic subdural hygroma and hematoma with IgG4-related hypertrophic pachymeningitis.

Background: Postoperative hydrocephalus and subdural fluid collection (SFC) have been reported as the rare complications following foramen magnum decompression in patients with Chiari malformation. Case Description: The paper reports the case of a 63-year-old female patient who underwent foramen magnum decompression for basilar invagination. The patient developed a shifting, bilateral SFC and subsequent acute hydrocephalus. A ventriculoperitoneal shunting was performed and the clinical symptom resolved. The dramatic change in CSF distribution supported the diagnosis of external hydrocephalus, which was associated with a postoperative cervical pseudomeningocele. Conclusions: Postoperative SFC in patients underwent foramen magnum decompression may harbor different mechanisms. Subdural drainage for patients having external hydrocephalus may have a higher recurrence rate.

Case: Two cases of postoperative spinal subdural extra-arachnoid hygromas were successfully treated with bed rest after patients developed symptoms 4 to 5 days following decompressive lumbar surgery. The development of the hygromas as well as the radiological findings are discussed., Conclusion: To the best of our knowledge, these comprise the first postoperative cases successfully treated without surgical re-exploration. This demonstrates conservative management may be a safe and effective management choice.

Accumulation of contrast medium in the subdural space after diagnostic intraarterial contrast administration is a rare observation. The authors report the case of a subdural contrast effusion (SCE) presenting during endovascular treatment of an intracranial dural arteriovenous fistula (DAVF) mimicking an acute subdural hematoma. Differentiation between the two by computed tomography (CT) or intraprocedural Dyna CT and early neurological examination can be crucial for patient management. We believe that repeated large-volume contrast injections via large-bore intermediate catheters into the territory of an (even partly) occluded DAVF may induce leakage of contrast medium into the extravascular subdural space thereby causing a SCE.

Introduction: Post-traumatic hydrocephalus following head injury is a well-known entity. Most cases occur in patients with severe head injuries, often following decompressive craniectomy. On the contrary, acute post-traumatic hydrocephalus, caused by aqueductal obstruction by a blood clot, following mild head injury is uncommon., Clinical Material: Six patients aged between 6 and 15 months presented hydrocephalus secondary to a blood clot in the aqueduct. Because of intracranial hypertension at presentation, 4 patients were urgently treated with external ventricular drains (EVDs). Post-operative course was uneventful. In 2 cases, EVDs were removed without further treatments. In 2 cases, hydrocephalus recurred. These patients were successfully treated with endoscopic third ventriculostomy. The remaining two patients developed symptoms a few days after the trauma. One, that presented hydrocephalus at imaging, was managed with a ventriculo-peritoneal shunt; the other, that presented subdural hygroma, was managed with subduro-peritoneal shunt that was removed later. All patients had complete recovery., Discussion and Conclusion: Hydrocephalus secondary to clot in the aqueduct may rarely be the result of mild head injury in young children. Usually, prompt surgical management warrants a very good outcome. Most children may be treated without a permanent shunt, by using external drains and endoscopic third ventriculostomy.

Objectives: In patients undergoing decompressive craniectomy for traumatic brain injury(TBI) there has been reported an incidence of hydrocephalus between 0-45%. There are several radiological and clinical features described in association with development of hydrocephalus. For study the influence of these factors we conducted a retrospective observational single-center cohort study in a tertiary care center with special attention to the transcalvarial herniation(TCH) volume after decompressive craniectomy., Patients and Methods: We selected 50 patients that underwent decompressive craniectomy after closed head injury between january 2014 and January 2015. Hydrocephalus was defined as a modified frontal horn index greater than 33%, presence of Gudeman CT scan criteria or insertion of ventriculoperitoneal Shunt. Variables analyzed were: age, post-resuscitation Glasgow coma scale (GCS) score, pupil reactivity, Zunkeller index, presence of hygroma, TCH volume, craniectomy diameter and distance of craniectomy from midline. Logistic regression was used with hydrocephalus as the primary outcome measure., Results: 17 patients developed hydrocephalus (34%). TCH volume after decompression(p < 0.01), subdural hygroma (p < 0.01), lower admission Glasgow Coma Scale score (p = 0.015), unilateral pupil reactivity(p = 0.042) and higher Zumkeller index(p = 0.044) were significant risk factors for hydrocephalus. Logistic regression analysis showed that factors independently associated with the development of hydrocephalus was the TCH volume (odds ratio 11.08; 95%CI 2.10, 58.4; p = 0.0046), and presence of hygroma (odds ratio 49.59; 95%IC 4.1, 459; p = 0.002)., Conclusions: There was a clear association between severity of TBI, TCH volume and subdural hygroma with the development of hydrocephalus. Clinicians should follow closely patients with those findings in order to avoid late deterioration., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Rationale: Atlantoaxial transarticular screw fixation has been an effective and appealing method for inducing fusion of the C1-C2 complex. This technique is usually performed with Gallie fusion. In performing Gallie fusion using sublaminar wiring, a major concern is the risk of dural tear associated with passing sublaminar wires through the epidural space. We present the first report on symptomatic symptomatic subdural hygroma (SDH) due to transarticular screw fixation with posterior wiring., Patients Concerns: A 50-year-old man had sustained dens fracture 20 years ago and presented with severe neck pain following a recent traffic accident. The images showed atlantoaxial instability due to nonunion of the dens fracture and the patient underwent transarticular screw fixation with posterior sublaminar wiring using Gallie technique. When the U-shaped wire was passed under the arch of C1 from inferior to superior, a dural tear and cerebrospinal fluid (CSF) leak occurred. The site of dural tear was repaired by direct application of sutures. The patient was discharged in good condition. Fifteen day after surgery, the patient was readmitted with a history of a progressive headache associated with vomiting and vertigo., Diagnonsis: Brain CT and MRI showed bilateral posterior fossa and a right-sided supratentorial SDH., Interventions: The patient underwent right occipital burr hole and evacuation of posterior fossa SDH due to deteriorating neurological status., Outcomes: The patient's condition gradually improved after the operation and became asymptomatic at 3-year follow-up., Lessons: Posterior fossa and supratentorial SDH could occur resulting from any intraoperative dural tear and CSF leakage during posterior cervical spinal surgery. Symptomatic SDH after posterior cervical spinal surgery should be cautiously assessed and treated., Level of Evidence: 5.

Decompressive craniectomy (DC) has been performed increasingly to control medically refractory intracranial hypertension in patients with traumatic brain injury (TBI). Although DC is a potentially life-saving procedure and technically straightforward, it is associated with some significant complications that include subdural hygroma (SDG) and posttraumatic hydrocephalus (PTH). A retrospective analysis of 143 TBI patients who underwent unilateral DC was undertaken to investigate the incidence and risk factors of PTH and investigate the relationship between the types of SDG and PTH. Among these patients, the incidence of PTH was 30.1%. SDG was noted in 25 patients (58.1%) who developed PTH. SDG was noted in 27 patients (27%) without PTH. The patients with PTH had a significantly unfavorable outcome (p < 0.0001). After stepwise logistic regression analyses, only age (p = 0.004, odds ratio [OR] = 1.036, 95% confidence interval [CI] = 1.011-1.061) and contralateral SDG (p < 0.0001, OR = 5.613, 95% CI = 2.232-14.115) remained independently associated with PTH development, and PTH development rate increased by 3.6% with every 1-year increase in age. Close surveillance is indicated in older TBI patients with contralateral SDG after unilateral DC to prompt early detection and timely management of PTH., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Subdural hygromas are often found bilaterally in spontaneous intracranial hypotension (SIH). They frequently progress to chronic subdural hematomas (CSDHs), and if the hematomas are formed, it is difficult to consider SIH as an underlying cause. Whether SIH is underlying or not among the patients presenting bilateral subdural fluid collections (hygromas or CSDHs) is clinically important because the treatment strategy should be different between them., Objectives: We designed a retrospective case-control study to figure out differential clinical features of the patients presenting bilateral symptomatic subdural fluid collections owing to SIH., Methods: Sixty-two patients with bilateral symptomatic subdural fluid collections were enrolled, and their data on general demographics, clinical courses, radiological findings, treatments, and outcomes were collected. The patients were divided into "SIH" and "Non-SIH" groups, and a simple logistic regression analysis was performed to clarify the differences between the groups. The consequent receiver operating characteristics (ROC) curve analyses were performed with the significant predictors., Results: Eight patients (13%) were diagnosed with SIH. Young age (odds ratio [OR] = 0.831, 95% confidence interval [CI]: 0.743-0.929, P = .0012), no underlying disease (OR = 0.062, 95% CI: 0.007-0.544, P = .0121), radiological features of brain sagging (OR = 10.36, 95% CI: 0.912-93.411, P = .0017), pseudo-subarachnoid hemorrhage (OR = 15.6, 95% CI: 2.088-116.52, P = .0074), and small amount of fluid collections (OR = 0.719, 95% CI: 0.579-0.893, P = .0029) were significantly associated with SIH group. ROC curve analyses were performed in parameters of age and amount of fluid collection and the cut-off values for each parameter were ≤55 years old and ≤22.08 mm, respectively. Patients diagnosed with SIH underwent epidural blood patches and showed good results, except 1 patient who underwent burr-hole trephinations., Conclusion: Bilateral subdural fluid collections due to underlying SIH is associated with young age (≤55 years old), no underlying diseases, smaller amount of fluid collections (≤22.08 mm of depth), and radiological findings of brain sagging or pseudo-subarachnoid hemorrhages., (© 2019 American Headache Society.)

Objective: Various surgical techniques have been described to treat subdural fluid collections in infants, including transfontanelle aspiration, burr holes, subdural drain, subduroperitoneal shunt, and minicraniotomy. The purpose of this study was to describe a modification of the minicraniotomy technique that avoids the implantation of external drainage catheters and potentially carries a higher success rate., Methods: In this retrospective study, the authors describe 11 cases involving pediatric patients who underwent parietal minicraniotomies for the evacuation of subdural fluid collections. In contrast to cases previously described in the literature, no patient received a drain; instead, a subgaleal pocket was created such that the fluid could flow from the subdural to the subgaleal space. Preoperative and postoperative data were reviewed, including neurological examination findings, radiological findings, complications, hospital length of stay, and findings on follow-up examinations and imaging. The primary outcome was failure of the treatment strategy, defined as an increase in subdural fluid collection requiring further intervention., Results: Eleven patients (8 boys and 3 girls, median age 4.5 months) underwent the described procedure. Eight of the patients had complete resolution of the subdural collection on follow-up imaging, and 2 had improvement. One patient had a new subdural collection due to a second injury. Only 1 patient underwent aspiration and subsequent surgical repair of a pseudomeningocele after the initial surgery. Notably, no patients required subduroperitoneal shunt placement., Conclusions: The authors describe a new surgical option for subdural fluid collections in infants that allows for more aggressive evacuation of the subdural fluid and eliminates the need for a drain or shunt placement. Further work with more patients and direct comparison to other alternative therapies is necessary to fully evaluate the efficacy and safety of this new technique.

Life-threatening physical abuse of infants and toddlers is frequently correlated with head injuries. A common variant of the abusive head trauma is the shaken baby syndrome. The present review article sheds light on subdural collections in children with abusive head trauma and aims at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. To this end, the different subdural collection entities are presented and illustrated. The pathophysiologic background is explained. Differential and age-diagnostic aspects are discussed and summarized by tabular and graphic overviews. Two problematic constellations frequently occurring during initial CT investigations are evaluated: A mixed-density subdural collection does not prove repeated trauma, and hypodense subdural collections are not synonymous with chronicity. The neuroradiologic analysis and assessment of subdural collections may decisively contribute to answering differential diagnostic and forensic questions. In addition to more reference data, a harmonization of terminology and methodology is urgently needed, especially with respect to age-diagnostic aspects., (© 2019 by American Journal of Neuroradiology.)

Background: Subdural effusion with hydrocephalus (SDEH) is a rare complication of traumatic brain injury, especially following decompressive craniectomy (DC) for posttraumatic cerebral infarction. The diagnosis and treatment are still difficult and controversial for neurosurgeons., Case Presentation: A 45-year-old man developed traumatic cerebral infarction after traumatic brain injury and underwent DC because of the mass effect of cerebral infarction. Unfortunately, the complications of traumatic subdural effusion (SDE) and hydrocephalus occurred in succession following DC. Burr-hole drainage and subdural peritoneal shunt were performed in sequence because of the mass effect of SDE, which only temporarily improved the symptoms of the patient. Cranioplasty and ventriculoperitoneal shunt were performed ultimately, after which SDE disappeared completely. However, the patient remains severely disabled, with a Glasgow Outcome Scale of 3., Conclusions: It is important for neurosurgeons to consider the presence of accompanying hydrocephalus when treating patients with SDE. Once the diagnosis of SDEH is established and the SDE has no mass effect, timely ventriculoperitoneal shunt may be needed to avoid multiple surgical procedures, which is a safe and effective surgical method to treat SDEH.

Objective: Hydrocephalus associated with subdural hygromas is a rare complication after decompression of Chiari malformation type I (CM-I). There is no consensus for management of this complication. The authors present a series of 5 pediatric patients who underwent CM-I decompression with placement of a dural graft complicated by posterior fossa hygromas and hydrocephalus that were successfully managed nonoperatively., Methods: A retrospective review over the last 5 years of patients who presented with hydrocephalus and subdural hygromas following foramen magnum decompression with placement of a dural graft for CM-I was conducted at 2 pediatric institutions. Their preoperative presentation, perioperative hospital course, and postoperative re-presentation are discussed with attention to their treatment regimen and ultimate outcome. In addition to reporting these cases, the authors discuss all similar cases found in their literature review., Results: Over the last 5 years, the authors have encountered 194 pediatric cases of CM-I decompression with duraplasty equally distributed at the 2 institutions. Of those cases, 5 pediatric patients with a delayed postoperative complication involving hydrocephalus and subdural hygromas were identified. The 5 patients were managed nonoperatively with acetazolamide and high-dose dexamethasone; dosages of both drugs were adjusted to the age and weight of each patient. All patients were symptom free at follow-up and exhibited resolution of their pathology on imaging. Thirteen similar pediatric cases and 17 adult cases were identified in the literature review. Most reported cases were treated with CSF diversion or reoperation. There were a total of 4 cases previously reported with successful nonoperative management. Of these cases, only 1 case was reported in the pediatric population., Conclusions: De novo hydrocephalus, in association with subdural hygromas following CM-I decompression, is rare. This presentation suggests that these complications after posterior fossa decompression with duraplasty can be treated with nonoperative medical management, therefore obviating the need for CSF diversion or reoperation.

Background: Endoscopic third ventriculostomy (ETV) has overtaken the use of a ventriculoperitoneal shunt for the treatment of congenital hydrocephalus. Although ETV is relatively safe, several postoperative complications have been reported. One of the least described and understood complications is subdural hygroma following third ventriculostomy., Methods: In this series, we retrospectively analyzed patients who were managed for postventriculostomy subdural hygroma and analyzed the possible factors responsible for this condition., Results: A total of 248 patients who underwent ETV between 2014 and 2016 were included in this study. Twelve patients (4.8%) had developed subdural hygroma, including 6 patients with bilateral hygroma, 2 with contralateral hygroma, and 4 with ipsilateral subdural hygroma. Only 4 patients (1.6%) were symptomatic, with complains of pseudomeningocele, persistent vomiting, or headache. Significant mass effect was present in 2 patients with unilateral subdural hygroma, which improved after placement of a subduroperitoneal shunt. In 1 patient, the subdural hygroma decreased with persistent ventriculomegaly and improved after ventriculoperitoneal shunt implantation. One patient with posttraumatic hydrocephalus who had a bilateral subdural hygroma following ETV improved with conservative management. At a 12-month follow-up, all patients remained asymptomatic., Conclusions: Post-ETV subdural hygroma may result from poor absorption of cerebrospinal fluid (CSF) in the subarachnoid space, dysfunction of the stoma with persistence of the ventriculosubdural fistula, or altered CSF cytology, such as hemorrhage. Most of these patients remain asymptomatic and improve with time. Symptomatic patients should be properly evaluated for the cause of the formation of subdural hygroma, which will guide the appropriate interventions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The appearance of a subdural hygroma after the rupture of an arachnoid cyst wall is extremely rare, with very few cases described in the literature. Most cases are due to a traumatic cause. The therapeutic approach in symptomatic cases is controversial, with a current tendency toward conservative management initially. In those cases that require surgical treatment, multiple therapeutic options are available, with fenestration techniques being recommended as first-line treatment. We describe 2cases treated in our centre and review the literature., (Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Spontaneous resolution of acute subdural hematomas (SDHs), occurring as the result of a traumatic injury, is well reported in the literature and rapidly resolving SDHs have been reported as well. Although the mechanism behind the rapid resolution of a SDH has not been well understood, there are postulated mechanisms for this phenomenon. The aim of this report is to present a patient who experienced the rapid resolution of a traumatic SDH, which was replaced by a subdural hygroma., Case Description: This 25-year-old man presented to the hospital with an acute left-sided SDH after a head-on motor vehicle collision. At the time of presentation, the patient had an acute SDH with 11 mm of midline shift. The hematoma resolved spontaneously within 48 hours and was replaced by a thin subdural hygroma., Conclusions: Rapidly resolving SDHs represent a phenomenon that has been well described, although is not entirely understood. The imaging findings of this patient suggest that cerebrospinal fluid washout is a mechanism that promotes acute SDH resolution., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective To evaluate the effectiveness of early (<3 months) cranioplasty (CP) and late CP (>3 months) on post-operative complications in patients receiving decompressive craniotomy (DC) for traumatic brain injury (TBI). Methods The Cochrane Library, PubMed and EMBASE databases were systematically searched for studies published prior to May 21, 2017. A meta-analysis examined post-operative overall complication rates, infection rates, subdural fluid collection and operating times according to early and late CP. Results Of the initial 1675 references, five studies, all cohort, involving a total of 413 patients, were selected for the review. There was no difference between early and late CP in post-operative overall complication rate (RR=0.68, 95%CI [0.36, 1.29]) and the post-operative infection rate (RR=0.50, 95%CI [0.20, 1.24]) in patients receiving DC for TBI. However, there was a significant difference in post-operative subdural effusion (RR=0.24, 95%CI [0.07, 0.78]) and mean operative time (mean difference = -33.02 min, 95%CI [-48.19, -17.84]) both in favour of early CP. Conclusions No differences were found between early and late CP in post-operative overall complications and procedural related infections in patients receiving DC for TBI, but early CP reduced the complication of subdural effusion and the mean operating time. These findings need to be confirmed by large, randomised controlled trials.