The Risk Factors of Subdural Hygroma after Decompressive Craniectomy

Abstract

Objective: Subdural effusion, also known as subdural hygroma (SDG), is a secondary complication that can occur after decompressive craniectomy (DC). However, the pathogenesis of SDG is not fully understood. It is unclear whether SDG occurrence is related to preoperative patient status or surgical technique. The purpose of this study is to identify risk factors for SDG after DC.

Methods: Fifty-nine patients who underwent DC from January 2016 to December 2016 at the same institution were analyzed. We retrospectively reviewed the clinical and radiological features of the patients. We divided the patients into two groups based on the occurrence of SDG after DC. The risk factors for SDG were analyzed.

Results: The overall SDG rate after DC was 39% (23 patients). A statistically significant association was observed between preoperative diagnosis, e.g., subdural hemorrhage (SDH; odds ratio [OR], 4.99; 95% confidence interval [CI], 1.36-18.34) or subarachnoid hemorrhage (SAH; OR, 4.18; 95% CI, 1.07-16.32), and the occurrence of SDG after DC. Traumatic brain injury (OR, 4.91; 95% CI, 1.35-17.91) and preoperative cortical opening (OR, 4.77; 95% CI, 1.39-16.32) were important risk factors for SDG. Several surgical techniques did not show a statistically significant association with SDG. The occurrence of SDG after DC was related to the length of hospital stay (p=0.012), but not to prognosis.

Conclusion: After DC, SDG is not related to patients' prognosis but to the length of hospital stay. Therefore, it is necessary to study the occurrence of postoperative SDG by confirming the presence of preoperative SDH, SAH, and cortical opening.

Keywords: Decompressive craniectomy; Subarachnoid hemorrhage; Subdural effusion.

FIGURE 1. (A, B) The skull anteroposterior/lateral images. (B) Bone flap size measure: largest transverse diameter (D) × vertical diameter perpendicular to D (d) × π/4. m: craniectomy margin from midline.

FIGURE 2. The computed tomography (CT) images of a 19-year-old female having fall down injury. (A) Traumatic subarachnoid hemorrhage on all cistern and basal cistern compression was noted. (B) Immediately after postoperative CT, bilateral decompressive craniectomy was performed. (C) Postoperative day 3, minimal subdural hygroma (SDG) was seen. (D) Postoperative day 15, there is a definite increase of SDG.