External subdural drainage in the treatment of infantile chronic subdural hematoma.
BACKGROUND
The management of chronic subdural hematoma (CSDH) in infants remains controversial. The purpose of this study was to analyze the clinical characteristics of CSDH in infancy and evaluate the efficacy of continuous external subdural drainage in the treatment of infantile CSDH.


METHODS
We prospectively collected 36 consecutive infants with CSDH, to receive continuous external subdural drainage as the initial management. Medical records were reviewed for comparison of age, gender, cause of injury, clinical presentation, surgical management, and outcome. Diagnosis was made by computed tomography and/or magnetic resonance imaging.


RESULTS
There were 20 boys and 16 girls, with ages ranging from 1 to 11 months (average, 5.9 months). The most common cause of CSDH was head injury (44.5%), followed by shaken baby syndrome (36.1%). The most common clinical presentations were seizure, bulging fontanel, and consciousness disturbance. Continuous external subdural drainage was the definite treatment in 34 patients (94.4%). The drains were left in place for no more than 9 days. Only two (5.6%) patients needed permanent subduroperitoneal shunting. No obvious complication was found. At follow-up (17-160 months; mean, 86.6 months), 23 (63.9%) had good recovery, 5 (13.9%) had moderate disability, 3 (8.3%) had severe disability, 4 (11.1%) were in a vegetative state, and 1 (2.8%) died.


CONCLUSIONS
Continuous external subdural drainage was an effective treatment in infantile CSDH, with a low complication rate and good clinical outcome. It might be considered as a strategy before subduroperitoneal shunting in the treatment of CSDH in infants.
Lin
Chih-Lung
CL
Division of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. chihlung1@yahoo.com
Hwang
Shiuh-Lin
SL
Su
Yu-Feng
YF
Tsai
Ling-Chin
LC
Kwan
Aij-Lie
AL
Howng
Shen-Long
SL
Loh
Joon-Khim
JK
D006259:Craniocerebral Trauma / Q000150:complications*; D004322:Drainage; D005260:Female; D015600:Glasgow Coma Scale; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D011446:Prospective Studies; D011859:Radiography; D038642:Shaken Baby Syndrome / Q000150:complications*; D013355:Subdural Space; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome