Cranioplasty as the treatment for contralateral subdural effusion secondary to decompressive craniectomy: a case report and review of the relevant literature

Intractable subdural effusion after decompressive craniectomy for traumatic brain injury: A case report

BACKGROUND

Traumatic subdural effusion is a common complication of traumatic brain injury, especially after decompressive craniectomy (DC). For neurosurgeons, early diagnosis and timely treatment are particularly important, which can help improve patient prognosis and enhance quality of life.

CASE SUMMARY

A 47 year old male underwent DC for traumatic brain herniation. After surgery, he developed stubborn subdural effusion (SDE) on the contralateral side and underwent multiple subdural drilling and drainage surgeries, but only temporarily improved the patient’s symptoms. After the final cranioplasty, the contralateral SDE completely disappeared. The patient did not experience any new contralateral neurological dysfunction, and the Glasgow prognostic score was 11 points (E4V1M6).

CONCLUSION

For neurosurgeons, accurate assessment of the condition is necessary when treating patients with stubborn SDE after DC surgery, and timely cranioplasty can be performed to avoid multiple surgeries. This is a safe and effective surgical method for treating traumatic subdural effusion.

Complications Following Decompressive Craniectomy

Decompressive craniectomy (DC) is performed to treat refractory intracranial hypertension following traumatic brain injury and stroke. Though technically not demanding, DC is still associated with several early and delayed complications. Early complications can be fatal, whereas delayed complications may result in regression of recovery. Adequately sized DC along with aggressive medical management mitigates most of the acute complications whereas early cranioplasty prevents delayed complications.

Application of 3D-Printed External Cranial Protection in the Treatment of Contralateral Subdural Effusion After Decompressive Craniectomy: A Technical Note

This technical note introduces the application of a 3D-printed external cranial protection device for contralateral subdural effusion after decompressive craniectomy (CSEDC). By applying this device over the cranial defect, the authors observed significant effects in reducing CSEDC formation, alleviating midline shift, and promoting neurological recovery. This report details the design and manufacturing process and presents comparative computed tomography images of a representative patient to demonstrate its efficacy.

Is cranioplasty the optimal treatment for contralateral subdural effusion after decompressive craniectomy?: a case report

Introduction and importance

Contralateral subdural effusion (CSDE) is a rare complication secondary to decompressive craniectomy (DC), which can lead to encephalocele and neurologic deterioration. The authors report a case that confirm the existence of unidirectional membrane valve, and cranioplasty is an effective treatment for CSDE.

Case presentation

The authors reported a case of 43-year-old female was diagnosed with ruptured intracranial aneurysm and treated with interventional embolization. She underwent DC because of postoperative cerebral infarction subsequently. Her conscious state deteriorated accompanied by encephalocele in postoperative 2 week. A craniocerebral computed tomography (CT) confirmed the diagnosis of CSDE with cerebral hernia. A compression bandaging of the skull defect was applicated, whereas, her conscious state progressive deteriorated. She was transferred to the author's hospital where she underwent burr-hole drainage and clinical symptom has been improved. However, a relapse of CSDE was observed after the removal of drainage tube. Continuous lumbar drainage was employed, and which was ineffective for CSDE in this case. Finally, she underwent cranioplasty, with the help of drainage of subdural effusion, CSDE was completely resolved.

Clinical discussion

CSDE is occasionally observed in patients after DC. Intracranial pressure (ICP) gradient and unidirectional membrane valve are the possible mechanisms of CSDE. At present, there is no optimal therapy for CSDE. For symptomatic CSDE patients, one or more treatment measures should be applicated.

Conclusion

Cranioplasty is one of the curative and optimal method to treat symptomatic CSDE patients, early cranioplasty combined with burr-hole drainage should be performed for conservative treatment failed and intractable cases.