Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Department of Emergency and Trauma Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
J Int Med Res. 2020 Nov;48(11):300060520966890. doi: 10.1177/0300060520966890.
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.
硬膜下积液（SDE）是去骨瓣减压术后（DC）的常见并发症。本病例报告描述了一例具有典型临床过程的对侧 SDE 患者。最初，他因头部外伤导致意识丧失而接受了去骨瓣减压术，术后恢复良好。然而，每次从植入 SDE 腔的 Ommaya 储液器中进行经皮抽吸液体后，他仅获得暂时缓解。最终他被转至作者所在医院，接受了颅骨成形术，这最终导致他对侧 SDE 的减少和消失。出乎意料的是，颅骨成形术后 2 周，他的临床状况再次恶化，出现无法控制的膀胱症状。随后的 CT 扫描发现整个脑室内系统明显扩张，表明有症状的交通性脑积水。随后他接受了脑室-腹腔分流术，结果预后良好，两周后出院。对当前文献的回顾仅发现 14 例单独通过颅骨成形术治愈的对侧 SDE 病例。对侧 SDE 的发生机制已被广泛讨论。尽管对侧 SDE 的确切机制以及颅骨成形术为何有效的机制仍不清楚，但颅骨成形术可能是对侧 SDE 的一种替代治疗选择。
