Hydrocephalus and macrocrania: surgical or non-surgical treatment of postshunting subdural hematoma?
BACKGROUND
Subdural hematoma is a well-known complication of hydrocephalus shunting procedures. Since the advent of modern neuroimaging techniques, a more realistic incidence of subdural hematomas in shunted patients has been recognized. The description of several asymptomatic cases raises the problem of choosing the most appropriate therapeutic policy for such a condition.


METHODS
We report two cases with long standing hydrocephalus and macrocrania in which bilateral huge acute and subacute postshunting subdural hematoma developed and remained asymptomatic.


RESULTS
The first patient was treated initially by surgery. Subsequently, despite the persistence of the subdural collections, a nonsurgical policy was chosen. The second patient was deliberately nonsurgically treated.


CONCLUSIONS
On the basis of our experience, we conclude that a nonsurgical policy should be followed in patients with long standing hydrocephalus and macrocrania, if they develop postshunting large hemorrhagic subdural collections and remain asymptomatic.
Puca
A
A
Institute of Neurosurgery and Radiology, Catholic University, Rome, Italy.
Fernandez
E
E
Colosimo
C
C
Lauretti
L
L
Pallini
R
R
Tamburrini
G
G
D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D012886:Skull / Q000473:pathology*; D014057:Tomography, X-Ray Computed