Lee Hee Chang, Chong Sangjoon, Lee Ji Yeoun, Cheon Jung-Eun, Phi Ji Hoon, Kim Seung-Ki, Kim In-One, Wang Kyu-Chang
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Division of Pediatric Radiology, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Childs Nerv Syst. 2018 Feb;34(2):235-245. doi: 10.1007/s00381-017-3583-y. Epub 2017 Sep 9.
Benign extracerebral fluid collection (bECFC) can be complicated by subdural hematoma (SDH) or subdural fluid collection (SDFC). The etiology, natural history, and management strategy for SDH/SDFC in bECFC are not fully understood. We retrospectively reviewed the cases of bECFC patients complicated with SDH/SDFC and tried (1) to confirm the fact that bECFC children are vulnerable to SDH/SDFC, (2) to investigate the clinical significance of 'trauma history' witnessed by a caregiver, and (3) to determine optimal management for them.
Among 213 bECFC patients identified from January 2000 to August 2015, 20 patients (male:female = 14:6; median age, 6.5 months; range 1-16 months) complicated by SDH/SDFC documented with brain imaging were evaluated for their clinical manifestations, radiologic features, and management outcomes. The median follow-up period was 9.5 months. They were divided into two groups (traumatic group versus non-traumatic group) according to whether objective radiologic evidence of head injury was present or not, and the two groups were analyzed for any clinical differences between them. We also evaluated the clinical significance of witnessed traumatic events by caregivers as an additional independent variable in the analysis.
The incidence of SDH/SDFC in bECFC patients was 9.4% (20/213) in our data. In a comparative analysis, the traumatic group is more likely to have 'acute' stage SDH, whereas the non-traumatic group is more likely to have 'chronic' stage SDH. The trauma history witnessed by caregivers did not show clinical significance in the data analysis when included as an independent variable. The prognosis of SDH/SDFC in bECFC patients was favorable without surgery in most of patients regardless of whether the patient has evidence of head trauma or not.
Benign ECFC is vulnerable to SDH/SDFC development. For the bECFC patients complicated by SDH/SDFC, the trauma history witnessed by a caregiver did not show any clinical significance. A 'wait and watch' strategy is sufficient for the management of SDH/SDFC in bECFC patients.
良性脑外积液（bECFC）可能并发硬膜下血肿（SDH）或硬膜下积液（SDFC）。bECFC中SDH/SDFC的病因、自然病程及治疗策略尚未完全明确。我们回顾性分析了bECFC并发SDH/SDFC的病例，旨在（1）证实bECFC患儿易患SDH/SDFC这一事实；（2）探究照料者目睹的“外伤史”的临床意义；（3）确定针对此类患儿的最佳治疗方案。
在2000年1月至2015年8月期间确诊的213例bECFC患儿中，选取20例（男∶女 = 14∶6；中位年龄6.5个月；范围1 - 16个月）经脑部影像学检查证实并发SDH/SDFC的患儿，对其临床表现、影像学特征及治疗结果进行评估。中位随访期为9.5个月。根据是否存在头部损伤的客观影像学证据将患儿分为两组（创伤组与非创伤组），分析两组之间的临床差异。我们还将照料者目睹的创伤事件的临床意义作为分析中的一个额外独立变量进行评估。
在我们的数据中，bECFC患儿中SDH/SDFC的发生率为9.4%（20/213）。在对比分析中，创伤组更易出现“急性”期SDH，而非创伤组更易出现“慢性”期SDH。当将照料者目睹的外伤史作为独立变量纳入数据分析时，未显示出临床意义。无论患儿是否有头部外伤证据，大多数bECFC并发SDH/SDFC的患儿未经手术治疗预后良好。
良性脑外积液易并发SDH/SDFC。对于bECFC并发SDH/SDFC的患儿，照料者目睹的外伤史未显示出任何临床意义。“观察等待”策略足以应对bECFC患儿的SDH/SDFC。
