Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China.
Department of Neurosurgery, JiangShan People's Hospital, 9 Daohang Road, Jiangshan, Zhejiang 324100, China.
Clin Neurol Neurosurg. 2021 Nov;210:106950. doi: 10.1016/j.clineuro.2021.106950. Epub 2021 Sep 17.
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.
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.
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.
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.
去骨瓣减压术后发生对侧硬脑膜下积液（CSEDC）较为罕见，其最佳治疗方法尚未确定。我们报告 11 例 CSEDC 病例，并对相关英文文献进行综述。
我们在本院数据库中进行检索，并在 PubMed 和 Google Scholar 中进行英文文献检索。使用的关键词如下（单个词或组合）：“硬脑膜下血肿”；“硬脑膜下积液”；“去骨瓣减压术”。仅纳入我院有 CSEDC 且包含与分析相关的足够临床信息的患者。
我院记录了 11 例 CSEDC 病例。其中男性 10 例，女性 1 例，平均年龄 41.9 岁。所有 8 例有症状的患者均接受了手术治疗，CSEDC 逐渐缓解。文献中发现 68 例 CSEDC。包括我院的病例，共分析了 79 例患者。无症状患者接受保守治疗有效。41.7%的有症状 CSEDC 患者行颅骨钻孔引流术，成功引流 CSEDC。然而，其中 76%的患者因 CSEDC 再积聚而接受后续手术。25%的有症状患者行颅骨修补术，而 13.3%的患者因 CSEDC 复发后接受 Ommaya 引流。18.3%的有症状患者行颅骨修补加硬脑膜下腹腔分流术，所有 CSEDC 完全缓解。
颅骨钻孔引流似乎只是一种临时措施。对于 CSEDC 患者应尽早行颅骨修补术。对于 CSEDC 未解决或颅骨修补术后出现脑积水的患者，可能需要行脑脊液分流术。
