TITLE:
Subdural Hygroma: Different Treatment Modalities and Clinical Outcome
AUTHORS:
Mahmoud A. Almenzalawy, Abd Elhakeem A. Essa, Mahmoud H. Ragab
KEYWORDS:
Subdural Hygroma, Surgery, Conservative, Glasgow Coma Score
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.9 No.3,
May
8,
2019
ABSTRACT: Background: Subdural hygroma (SDHy) is a collection of cerebrospinal fluid (CSF) under the dural membrane. It is usually asymptomatic but may alter consciousness. Management is still a matter of controversy (conservative Vssurgical) especially when consciousness is a concern. Aim: To assess the different treatment modalities of SDHy regarding the patients’ characteristics and clinical outcome, finding out the significant differences and the future recommendations. Patients and Methods: In this prospective one-year clinical case study, thirty patients were included. Patients’ sociodemographic and clinical characteristics were analyzed. Fifteen patients were managed conservatively whereas the rest were managed surgically. Outcome was correlated with the patients’ characteristics. Results: Twenty four men (80%) and 6 women (20%). Mean age = 25.2 years old. Hygroma was unilateral in 63.3% and fronto-parietal in 60% of patients. The most frequent concomitant injuries were brain contusions (50%) and subarachnoid hemorrhage (33.3%), respectively. The conservative group was treated symptomatically. The surgical group had burr hole evacuation (12 patients) and subdural peritoneal shunt (3 patients). No statistical significance in outcome in either group, but surgical group showed better outcome (73.3%) than conservative group (53.3%). Younger patients have good outcome (65%) compared to (55.3%) in old patients. Patients with severe GCS showed poor outcome (8/8 patients, 100%), whereas mild and moderate GCS patients showed good outcome (19/22 patients, 86%). Conclusion: SDHy though is a benign lesion its management is a matter of controversy. The decision of surgery is affected by GCS and neurological deterioration. Generally, the surgical option is more favorable but the conservative option should be the role as far as there is no concern on consciousness.