title: "Rabbit ear" scalp deformity caused by massive subdural effusion in infant following bilateral bur-hole drainage failure: successfully managed with subduro-peritoneal shunt.
abstract: BACKGROUND
  Subdural effusion in an infant is a rare clinical scenario which may be secondary to a variety of etiologies. Massive subdural effusion is an extremely rare complication of head injury.
  
  
  METHODS
  Authors report a rare case of progressive massive subdural effusion which, despite bilateral bur-hole placement and drainage, failed and presented with visual deterioration and massive bulge of the scalp at bur-hole sites, producing a rabbit ear appearance in a 10-month-old infant. Ultimately, cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous bur-hole placement. This was followed by not only complete resolution of hygroma but also visual recovery. The patient is doing well at 6 months following shunt, regaining normal vision and appropriate developmental milestones. A MRI scan of the brain was carried out at last follow-up, which revealed mild ventriculomegaly with the rest of the brain being unremarkable, and subduro-peritoneal shunt in situ. Such a case has not been reported in the literature till date.
  
  
  CONCLUSIONS
  Subdural effusion usually runs a self-limiting course. Though neurosurgical intervention is occasionally needed, different methods of surgical procedure for management include bur hole alone, bur holes with subdural drain placement, twist drill craniotomy with drain, and even craniotomy. Various methods of management are discussed along with a review of pertinent literature.
authors.affiliation: Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India, duttaguru2002@yahoo.com.
authors.forename: Guru Dutta
authors.initials: GD
authors.lastname: Satyarthee
authors.forename: Pankaj
authors.initials: P
authors.lastname: Dawar
authors.forename: Bhawani Shanker
authors.initials: BS
authors.lastname: Sharma
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D003399:Craniotomy / Q000009:adverse effects*; D004322:Drainage; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D010537:Peritoneum / Q000601:surgery; D012535:Scalp / Q000473:pathology*; D013353:Subdural Effusion / Q000150:complications* / Q000601:surgery; D013355:Subdural Space / Q000601:surgery; D016896:Treatment Outcome