title: Simultaneous cranioplasty and subdural-peritoneal shunting for contralateral symptomatic subdural hygroma following decompressive craniectomy.
abstract: BACKGROUND
  Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits.
  
  
  METHODS
  Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications.
  
  
  RESULTS
  Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma.
  
  
  CONCLUSIONS
  The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus.
authors: Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; Department of Neurosurgery, Taipei City Hospital, Zhong Xiao Branch, Taipei, Taiwan ; Department of Biotechnology and Animal Science, College of Bioresources, National Ilan University, Yilan, Taiwan.
authors: Muh-Shi
authors: MS
authors: Lin
authors: Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors: Tzu-Hsuan
authors: TH
authors: Chen
authors: Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan ; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan ; Department of Neurosurgery, Lo-Hsu Foundation, Lotung Poh-Ai Hospital, Luodong, Yilan, Taiwan.
authors: Woon-Man
authors: WM
authors: Kung
authors: Department of Mathematics, Tunghai University, Taichung, Taiwan ; Sustainability Research Center, Tunghai University, Taichung 40704, Taiwan.
authors: Shuo-Tsung
authors: ST
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery*; D019904:Polymethyl Methacrylate / Q000008:administration & dosage; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013355:Subdural Space / Q000601:surgery*; D014025:Titanium / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D019904:Polymethyl Methacrylate; D014025:Titanium