Some concluded that early cranioplasty (less than 12 weeks) had a better functional outcome and complication rates were not different between early and late cranioplasty groups.17,18 Others have also emphasised on early cranioplasty after DC to alleviate complications from craniectomy.19 One study reported that early cranioplasty reduces operative time by facilitating soft tissue dissection before massive scar formation without causing additional complications like blood loss, infection,
subdural hygroma, and brain parenchymal damage.20
The medical records show that on the 6th of March the patient was diagnosed with ventriculitis, on the 14th with multiple stress ulcers, on the 24th with left fronto-temporal
subdural hygroma, subsequently drained and on the 3rd of April a CT scan showed a subdural haematoma on the site of the drained hygroma and dilation of the ventricular system.
(4,5) Although the term dural ectasia is preferred to describe the optic nerve sheath dilation, optic hydrops, primary cyst of the optic nerve sheath, patulous subarachnoid space, cystic hygroma, arachnoid cyst, and perioptic
subdural hygroma terms were all used to describe this entity since its first description in 1918.
We report a case of
subdural hygroma secondary to accidental dural puncture while inserting an epidural catheter for postoperative analgesia.
(20) In rare cases, symptoms related to arachnoid cysts occur secondary to the rupture of these entities and the formation of a
subdural hygroma and intracranial hypertension.
This may exacerbate the occurrence of
subdural hygromas and hydrocephalus.14,22,44 Researchers reported a 50% rate of
subdural hygroma and hydrocephalus following DC, regressing spontaneously over weeks to months.47 Others have reported a 21% rate of
subdural hygroma, 87% resolving spontaneously without having any resultant neurological deficit.45 Only one patient developed hydrocephalus in our study group who was treated through placement of a ventriculoperitoneal shunt.
(11) Other intracranial findings may include:
subdural hygromas or hematomas, enlargement of the pituitary gland, ventricular collapse, engorged dural venous sinuses or plexus, and superficial siderosis.
Compensatory subdural effusions can develop, which in some cases also causes rupture of subdural bridging veins transforming
subdural hygromas into subdural hematomas and thereby adding additional downward herniation force [19].
Parameters recorded were mortality, neurological outcome / complications like brain herniation, wound dehiscence, cerebrospinal fluid (CSF) leak, contusion expansion, sinking flap syndrome,
subdural hygromas and hydrocephalus.
Bilateral
subdural hygromas or hematomas may also accompany intracranial hypotension, and can be identified on the initial scan, although the cause of the collections may not be immediately recognized.