Pazniokas Julia, Harris William, Alshareef Mohammed, Alexander Allyson L, Hankinson Todd C, Handler Michael H, Wilkinson C Corbett, Samples Derek C
Department of Neurosurgery, University of Colorado, Aurora, CO, USA.
Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA.
Childs Nerv Syst. 2024 Dec 16;41(1):55. doi: 10.1007/s00381-024-06712-1.
Subdural fluid collection is a common neurosurgical condition in the pediatric population. Patients requiring surgical intervention have historically been managed with subdural drains, subdural-subgaleal shunting, subdural-peritoneal shunting, and mini-craniotomies. An alternative procedure for patients with an open anterior fontanelle is bedside transfontanelle drainage. This study aims to evaluate the efficacy of the transfontanelle angiocatheter drain placement including complications and the need for any further surgery.
We performed a single-center retrospective review of all patients who underwent placement of transfontanelle drain to treat subdural fluid collections from January 2013 to June 2023. Data points collected included demographics, comorbidities, mechanism of subdural collection, neurologic status on presentation, subdural size, amount of drainage, complications, and need for further intervention.
We identified 28 patients who underwent bedside transfontanelle subdural angiocatheter placement between January 2013 and June 2023. The patient age range was 0-11 months (avg 3.96). Twenty-three patients were male (82%). Nineteen patients (68%) had new seizures on presentation or during hospitalization. Eighteen patients (64%) suffered non-accidental trauma. The subdural on the side of the drainage ranged from 4 to 18 mm in size. On average, a total of 590 mL (22-1648) of fluid was drained over 3.5 (1-9) days. One medically complex patient on aspirin for cardiac comorbidities had post-procedural complication of new hemorrhage and one patient developed meningitis. Nineteen patients did not require any further treatment. Six patients underwent subsequent subdural-peritoneal shunting, two required subsequent placement of surgical subdural drains, and one underwent bilateral burr hole craniotomies with subdural drain placement. Patients who suffered NAT were more likely to not need further intervention than those with other mechanisms of subdural fluid collections.
This retrospective review demonstrates that bedside transfontanelle drain placement is an effective practice to reduce the need for operative intervention in infants with an open anterior fontanelle. The procedure can be performed expeditiously in the emergency room, ICU, or floor setting without the need for general anesthesia. While future larger prospective studies are warranted, our series documented this practice to be performed safely.
硬膜下积液是儿科常见的神经外科病症。历史上，需要手术干预的患者一直通过硬膜下引流、硬膜下-帽状腱膜下分流、硬膜下-腹腔分流和小型开颅手术进行治疗。对于前囟未闭的患者，一种替代方法是床边经囟门引流。本研究旨在评估经囟门血管导管引流置管的疗效，包括并发症以及是否需要进一步手术。
我们对2013年1月至2023年6月期间所有接受经囟门引流置管治疗硬膜下积液的患者进行了单中心回顾性研究。收集的数据点包括人口统计学资料、合并症、硬膜下积液的机制、就诊时的神经状态、硬膜下大小、引流量、并发症以及是否需要进一步干预。
我们确定了28例在2013年1月至2023年6月期间接受床边经囟门硬膜下血管导管置管的患者。患者年龄范围为0至11个月（平均3.96个月）。23例患者为男性（82%）。19例患者（68%）在就诊时或住院期间出现新发癫痫。18例患者（64%）遭受非意外创伤。引流侧的硬膜下大小为4至18毫米。平均而言，在3.5天（1至9天）内共引流590毫升（22至1648毫升）液体。一名因心脏合并症服用阿司匹林的病情复杂患者术后出现新的出血并发症，一名患者发生脑膜炎。19例患者无需进一步治疗。6例患者随后接受了硬膜下-腹腔分流，2例需要随后放置手术硬膜下引流管，1例接受了双侧钻孔开颅并放置硬膜下引流管。与其他硬膜下积液机制的患者相比，遭受非意外创伤的患者更有可能无需进一步干预。
这项回顾性研究表明，床边经囟门引流置管是一种有效的方法，可减少前囟未闭婴儿的手术干预需求。该操作可在急诊室、重症监护病房或病房环境中迅速进行，无需全身麻醉。虽然未来有必要进行更大规模的前瞻性研究，但我们的系列研究证明了这种操作的安全性。
