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Neurology India, Vol. 52, No. 1, January-March, 2004, pp. 121-122 Short Reports The use of reservoir shunt in chronic subdural hematoma Aydin MD Department of Neurosurgery, Medical Faculty, Ataturk University, Erzurum Code Number: ni04033 Abstract Recurrent chronic subdural hematomas (CSDH) can be a therapeutic challenge. We report the use of reservoir shunts for continuous irrigation and drainage of the subdural space for a prolonged period. This system appears to be more useful than an external drainage system.Introduction Treatment of CSDH in infancy is a therapeutic challenge.[1] A variety of treatment options like subdural tapping, endoscopic washout, shunting and craniotomy have been discussed.[2],[3] The use of continuous irrigation of the subdural cavity with the help of a reservoir shunt in the treatment of CSDH is discussed. Case Report An 8-month-old male infant presented with a history of generalized tonic convulsions, persistent vomiting and enlarging head circumference for 3 months. His past medical history was unremarkable. Head circumference was 51 cm. CT scan showed bilateral subdural hematoma. Hematoma was evacuated though a burr-hole and the subdural space was irrigated with isotonic solution. Reservoir shunts were inserted into the subdural space [Figure:1a]. Irrigation and drainage of the subdural space was performed by inserting a needle into the shunt chamber once a day for one month. The frequency of the irrigation and drainage was subsequently reduced to once a week in the second month. After the protein content of the subdural fluid had reduced below 210 mg/dl, reservoir shunts were withdrawn and the patient underwent subduroperitoneal shunt surgery. CT examination, performed two years after the operation, revealed disappearance of the subdural fluid [Figure:1b]. Discussion Treatment of CSDH of infancy can, on occasion, be a complex therapeutic challenge.[2],[4] The craniocerebral disproportion as a result of increased cranial volume and atrophic cerebral tissue, and recurrent collection of subdural fluid following drainage can both be difficult to treat. Burr-hole evacuation and drainage, shunting or craniotomy evacuation of subdural collection, all remain controversial forms of treatment.[2],[3],[4],[5] As the subdural fluid has a high protein content, placement of a conventional shunt system is complicated by repeated blockage. We observed that intermittent irrigation may be performed by reservoir shunt until the subdural fluid is suitable for shunt surgery. Reservoir shunts are safe and simple and if performed with due surgical safety, the risk of infection is minimal. References
Copyright 2004 - Neurology India The following images related to this document are available:Photo images[ni04033f1a.gif] [ni04033f1b.gif] |
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