Traumatic Subdural Hygroma: Nuances of Management

Abstract Background: Traumatic subdural hygroma (TSHg) is a collection of cerebrospinal fluid (CSF) in the subdural space following head injury. Despite being rather common, its onset and progression are unclear. The pathogenesis of TSHg is still uncertain. Aim of Study: This study attempts to discuss management based on the possible pathogenesis. Patients and Methods: Twenty patients with TSHg were studied clinically and by serial CT scans. TSHg was defined on CT as hypodense subdural fluid, without contrast enhance-ment or neomembrane formation, with at least 3mm between the skull and brain. Ventricle size was measured and quantified by the bicaudate index (BCI). Results: Twenty patients were collected prospectively during the period of the study. Ages ranged from 4 and 65 years with male predominance (16 patients). The main trauma mechanism was Road Traffic accidents in 11 patients, fall from height in 5 patients and 4 patients suffered from direct blow to the head. The period to develop the subdural hygroma ranged between 3 weeks to 2 months in our cohort. Ten of our patients were discovered accidently by the routine follow-up images, the other half of patients developed clinical signs of neuro-logical affection. Sixteen patients were subjected to surgical intervention. 12 patients had burr hole evacuation. 7 of them did not need further procedure whereas the other 5 had recollection and they needed shunt insertion. In 4 patients, the subdural col-lection was accompanied by ventriculomegaly for which they had a ventriculoperitoneal shunt from the beginning. Conclusions: Management of TSHg should be guided by the possible pathologies affecting the CSF pathway. The three groups probably represent a spectrum of CSF circulation impairment. Group 1 represents what is considered by most a simple hygroma, with no effect on CSF absorption. Group 2 represent the external hydrocephalus form, and group 3 were the cases presenting marked mass effect. With proper interpretation of clinical and CT findings, one can define the best treatment option.