3. MRI - brainstem morphology has returned to normal. Source of pictures: Wang Ji-sheng, Ji Nan “Compressive brainstem deformation resulting from subdural hygroma after neurosurgery: a case report” Gadolinium T1-MRI - diffuse, high enhancement of pachymeninges (small black arrows) together with bifrontal hygromas compressing frontal lobes (black arrows): Small, low-density, extra axial collection over right Benign enlargement of subarachnoid space in child (CT) – frontal lobe; slight mass effect; adjacent sulci are no mass effect; normally resolves within first 2 years of life: compressed: Postoperative MRI - child with large cystic craniopharyngioma and hydrocephalus; sudden tumor removal and hydrocephalus decompression resulted in subdural hygroma formation (small arrows); hygroma stretched draining veins, causing multiple venous infarcts (open arrow): Source of picture: Julian R. Youmans Neurological Surgery”, 4th ed. (1997); figure 126-7; Publisher: W.B. Saunders “Youmans Company; ISBN-10: 0721668453; ISBN-13: 978-0721668451 >> Asymptomatic observation (usually resolve spontaneously within several months). → N.B. observation leaves risk of transformation into subdural hematoma (which already requires craniotomy). Symptomatic (esp. deteriorating clinical status accompanied by hygroma volume↑ with brain compression herniation) surgery: external burr-hole drainage; → → maintain subdural drain for 24-48 hrs post-op; if satisfactory resorption does not occur shunting → of subdural space. recurrence following simple burr-hole drainage is common; for recurrent to locate site of CSF leak (may be very difficult) craniotomy subdural-peritoneal shunt may be placed. Bibliography for ch. Trauma” follow this “Head →
3. MRI - brainstem morphology has returned to normal. Source of pictures: Wang Ji-sheng, Ji Nan “Compressive brainstem deformation resulting from subdural hygroma after neurosurgery: a case report” Gadolinium T1-MRI - diffuse, high enhancement of pachymeninges (small black arrows) together with bifrontal hygromas compressing frontal lobes (black arrows): Small, low-density, extra axial collection over right frontal lobe; slight mass effect; adjacent sulci are compressed: Benign enlargement of subarachnoid space in child (CT) – no mass effect; normally resolves within first 2 years of life: Postoperative MRI - child with large cystic craniopharyngioma and hydrocephalus; sudden tumor removal and hydrocephalus decompression resulted in subdural hygroma formation (small arrows); hygroma stretched draining veins, causing multiple venous infarcts (open arrow): Source of picture: Julian R. Youmans “Youmans Neurological Surgery”, 4th ed. (1997); figure 126-7; Publisher: W.B. Saunders Company; ISBN-10: 0721668453; ISBN-13: 978-0721668451 >> Asymptomatic → observation (usually resolve spontaneously within several months). N.B. observation leaves risk of transformation into subdural hematoma (which already requires craniotomy). Symptomatic (esp. deteriorating clinical status accompanied by hygroma volume↑ with brain compression → herniation) → surgery: external burr-hole drainage; maintain subdural drain for 24-48 hrs post-op; if satisfactory resorption does not occur → shunting of subdural space. recurrence following simple burr-hole drainage is common; for recurrent craniotomy to locate site of CSF leak (may be very difficult) subdural-peritoneal shunt may be placed. Bibliography for ch. “Head Trauma” → follow this