Epidemiological Features of Patients with Subdural Hygroma in a Prospective Case Series

Abstract

Subdural hygroma is an accumulation of a cerebrospinal fluid-like fluid in the subdural space. It is a common epiphenomenon after a traumatic brain injury (TBI), but it may also occur after brain surgeries. A total of 17 patients in a prospective case series with subdural hygromas were analyzed. A male predominance (82.4%) was found. The mean age was 58.6 years. Traumatic brain injury was the main mechanism (76.5%); however, other mechanisms, such as post-craniotomy (17.6%), post-chronic subdural hematoma drainage (5.9%), and post-ventricle shunt (5.9%), were also observed. Incidental findings were diagnosed in 11.8% of the cases (mainly in elderly patients). Four patients required subdural shunt (23.5%)—all of them had TBI. Small subdural effusions were present in 35.5% of the cases. The mean time from admission to diagnosis was 6.1 days. The majority of the cases must have involved lesions of the dura–arachnoid interface since TBIs were the main causes of hygroma. The findings of incidental hygroma in elderly patients and its development after a ventricle shunt suggest that brain atrophy also plays a significant role in subdural hygroma formation.

Resumo

Higroma subdural é o acúmulo de fluido semelhante ao líquor no espaço subdural. É um epifenômeno comum após traumatismos crânio-encefálicos, mas também pode ocorrer após neurocirurgias. Nesta série de casos prospectiva, analisamos 17 pacientes com higroma subdural. Houve uma predominância no sexo masculino (82,4%). A idade média dos pacientes foi de 58,6 anos. Traumatismo crânio-encefálico foi o principal mecanismo (76,5%); porém outros mecanismos contribuíram para o surgimento de higroma: pós-craniotomia (17,6%), pós-drenagem de hematoma subdural crônico (5,9%), e pós-derivação ventricular (5,9%). Higromas incidentais foram diagnosticados em 11,8% dos casos (principalmente em pacientes mais velhos). Quatro pacientes necessitaram de derivação subdural (23,5%)—todos eles tiveram como mecanismo o traumatismo crânio-encefálico. Pequenas efusões subdurais estavam presentes em 35,5% dos casos. O tempo médio da admissão para o diagnóstico foi de 6,1 dias. A maioria dos casos deve ter tido lesão da interface duro-aracnoide, já que o traumatismo craniano foi a principal causa de higroma. Os achados de higromas incidentais em pacientes mais velhos e o seu desenvolvimento após derivações ventriculares sugerem que a atrofia cerebral desempenha também um papel significativo na formação de higromas subdurais.

Keywords

subdural hygroma - traumatic brain injury - cerebrospinal fluid - hydrocephalus

Palavras-chave

higroma subdural - traumatismo crânio-encefálico - líquor - hidrocefalia

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