Is Subdural Peritoneal Shunt Placement an Effective Tool for the Management of Recurrent/Chronic Subdural Hematoma?

Abstract

OBJECTIVE : To describe a surgical technique and to report using a retrospective study the efficacy of peritoneal shunts for the treatment of recurrent/chronic subdural hematoma (CSDH). We describe the considerations, complications, and outcomes related to this technique. METHODS : In a retrospective cohort study, 125 charts with a diagnosis of subacute/chronic subdural hematoma were assigned for evaluation. Of the charts reviewed, 18 charts were found from subjects with a diagnosis of recurrent sub-acute or chronic subdural hematoma. All patients had undergone initial surgical treatment of their condition followed by peritoneal shunt placement to help alleviate intracranial pressure. Factors including the age, size of subdural hematoma, number of previous events, BMI, complications, survival, and clinical course were analyzed. RESULTS : After subdural peritoneal shunt placement all patients had full neurological recovery with no complaints of headaches, lethargy, weakness, confusion or seizures. None of the cases had new subdural hematoma episodes after placement for a minimum of a two-year period (mean 26.1 months) (range 24.3-48.6 months). No postoperative complications were reported. The rates of postoperative hemorrhage, infection, distal catheter revision, and perioperative seizures was found to be zero percent. Shunt drainage was successful in all cases, draining 85% of the blood in the first 48 hours. There was no significant relationship between complications and the use of anticoagulants four weeks after surgery.

Conclusions: Peritoneal shunts, though rarely used, are a viable option in the treatment of sub-acute/chronic subdural hematomas. When pursuing this treatment, this technique is recommended to mitigate the risks of repeat surgical intervention and lessen perioperative time in high-risk patients.

Keywords: craniotomy; mental status; shunt; subdural hematoma; trauma.

Figure 1. Brain CT Scan Images

Figure 1A: Pre-op brain CT scan image demonstrating a large right subacute subdural hematoma causing subfalcine herniation, impending uncal herniation, right to the left shift of 1.0 cm mass effect and ipsilateral ventricles. Figure 1B: Brain CT scan demonstrating status post neurosurgical evacuation of right subdural hematoma. - Burr holes are present at the parietal convexity. Subdural drainage catheter, stable in position. Previously present right subdural air has resolved. No extra-axial fluid collections identified from the level of the foramen of Monro to the convexity. No acute intracranial hemorrhage.