gms | German Medical Science

Objective: Children with macrocephalus due to chronic subdural hematoma often need different types of hematoma tapping or fluid diversity. Some hematomas occur in case of suspected shaken baby syndrome. Several authors have shown that even at the first admission to hospital immediately after trauma subdural hematomas consist of chronic hygroma fluid. Acute subdural blood obviously does not seem to be a prerequisite for a chronic hypodense fluid volume. Several authors have shown that bridging vein thrombosis in infancy could be important for the origin and formation of the subdural fluid collections. This is the reason, why in most cases fluid diversion has to be performed for longer treatment periods, mostly several weeks or months. Evidence based data does not exist, which makes it important to investigate and analyze the own data and experiences if sufficient numbers exist.

Methods: We have analyzed data of different types of shunt diversion in 36 cases of CSDH in infancy (age < 24 months) out of a cohort of shunt procedures using a specific prospective shunt registry. Most of the children were suspected to be victims of abusive head trauma. 88 % showed an escalating head enlargement with prominence of the fontanel and developmental delay. 30 % were diagnosed with additional parenchymal concussions, 44 % had disturbances of their vigilance. The treatment options were immediate transfontanel tapping (1), intermittent puncture using Omaya reservoir (3), external fluid drains for several days (9), single sided subduroperitoneal shunts with valve interposition of different types (19) and valveless shunts (4). All fluid collections consisted of blood degradation products (100 %). All children had CT or MRI scans before and 3 months after surgery, mean follow up time was 24 months.

Results: Macrocephaly as the most important sign of the space occupying subdural collection could be treated successfully in all cases with subdural shunting. Children with major concussive parenchymal trauma had a poor outcome. Other children were treated successfully and could overcome their developmental delay after 6 months. Typical complications were subgaleal fluid collection and occlusion of the subdural catheter.

Conclusion: Valveless shunting using catheters with widened perforations was the most effective method to prevent shunt obstruction. Shunt explantation after therapeutic drainage period was avoided in most cases.