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Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of Chiari malformation type I: case series and review of the literature.
J Neurosurg Pediatr. 2018 Oct; 22(4):426-438.JN

Abstract

OBJECTIVE

Hydrocephalus associated with subdural hygromas is a rare complication after decompression of Chiari malformation type I (CM-I). There is no consensus for management of this complication. The authors present a series of 5 pediatric patients who underwent CM-I decompression with placement of a dural graft complicated by posterior fossa hygromas and hydrocephalus that were successfully managed nonoperatively.

METHODS

A retrospective review over the last 5 years of patients who presented with hydrocephalus and subdural hygromas following foramen magnum decompression with placement of a dural graft for CM-I was conducted at 2 pediatric institutions. Their preoperative presentation, perioperative hospital course, and postoperative re-presentation are discussed with attention to their treatment regimen and ultimate outcome. In addition to reporting these cases, the authors discuss all similar cases found in their literature review.

RESULTS

Over the last 5 years, the authors have encountered 194 pediatric cases of CM-I decompression with duraplasty equally distributed at the 2 institutions. Of those cases, 5 pediatric patients with a delayed postoperative complication involving hydrocephalus and subdural hygromas were identified. The 5 patients were managed nonoperatively with acetazolamide and high-dose dexamethasone; dosages of both drugs were adjusted to the age and weight of each patient. All patients were symptom free at follow-up and exhibited resolution of their pathology on imaging. Thirteen similar pediatric cases and 17 adult cases were identified in the literature review. Most reported cases were treated with CSF diversion or reoperation. There were a total of 4 cases previously reported with successful nonoperative management. Of these cases, only 1 case was reported in the pediatric population.

CONCLUSIONS

De novo hydrocephalus, in association with subdural hygromas following CM-I decompression, is rare. This presentation suggests that these complications after posterior fossa decompression with duraplasty can be treated with nonoperative medical management, therefore obviating the need for CSF diversion or reoperation.

Authors+Show Affiliations

2Department of Neurosurgery, University of South Florida, Tampa, Florida; and.1Department of Neurosurgery, Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg.3Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.3Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.1Department of Neurosurgery, Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg. 3Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.1Department of Neurosurgery, Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg.1Department of Neurosurgery, Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg.1Department of Neurosurgery, Johns Hopkins All Children's Institute for Brain Protection Sciences, St. Petersburg.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30028271

Citation

Vivas, Andrew C., et al. "Management of Hydrocephalus and Subdural Hygromas in Pediatric Patients After Decompression of Chiari Malformation Type I: Case Series and Review of the Literature." Journal of Neurosurgery. Pediatrics, vol. 22, no. 4, 2018, pp. 426-438.
Vivas AC, Shimony N, Jackson EM, et al. Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of Chiari malformation type I: case series and review of the literature. J Neurosurg Pediatr. 2018;22(4):426-438.
Vivas, A. C., Shimony, N., Jackson, E. M., Xu, R., Jallo, G. I., Rodriguez, L., Tuite, G. F., & Carey, C. M. (2018). Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of Chiari malformation type I: case series and review of the literature. Journal of Neurosurgery. Pediatrics, 22(4), 426-438. https://doi.org/10.3171/2018.4.PEDS17622
Vivas AC, et al. Management of Hydrocephalus and Subdural Hygromas in Pediatric Patients After Decompression of Chiari Malformation Type I: Case Series and Review of the Literature. J Neurosurg Pediatr. 2018;22(4):426-438. PubMed PMID: 30028271.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of Chiari malformation type I: case series and review of the literature. AU - Vivas,Andrew C, AU - Shimony,Nir, AU - Jackson,Eric M, AU - Xu,Risheng, AU - Jallo,George I, AU - Rodriguez,Luis, AU - Tuite,Gerald F, AU - Carey,Carolyn M, Y1 - 2018/07/20/ PY - 2018/7/22/pubmed PY - 2019/7/25/medline PY - 2018/7/21/entrez KW - CM-I = Chiari malformation type I KW - Chiari I malformation KW - ETV = endoscopic third ventriculostomy KW - FMD = foramen magnum decompression KW - complication KW - hydrocephalus KW - posterior fossa decompression KW - subdural hygromas SP - 426 EP - 438 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 22 IS - 4 N2 - OBJECTIVE: Hydrocephalus associated with subdural hygromas is a rare complication after decompression of Chiari malformation type I (CM-I). There is no consensus for management of this complication. The authors present a series of 5 pediatric patients who underwent CM-I decompression with placement of a dural graft complicated by posterior fossa hygromas and hydrocephalus that were successfully managed nonoperatively. METHODS: A retrospective review over the last 5 years of patients who presented with hydrocephalus and subdural hygromas following foramen magnum decompression with placement of a dural graft for CM-I was conducted at 2 pediatric institutions. Their preoperative presentation, perioperative hospital course, and postoperative re-presentation are discussed with attention to their treatment regimen and ultimate outcome. In addition to reporting these cases, the authors discuss all similar cases found in their literature review. RESULTS: Over the last 5 years, the authors have encountered 194 pediatric cases of CM-I decompression with duraplasty equally distributed at the 2 institutions. Of those cases, 5 pediatric patients with a delayed postoperative complication involving hydrocephalus and subdural hygromas were identified. The 5 patients were managed nonoperatively with acetazolamide and high-dose dexamethasone; dosages of both drugs were adjusted to the age and weight of each patient. All patients were symptom free at follow-up and exhibited resolution of their pathology on imaging. Thirteen similar pediatric cases and 17 adult cases were identified in the literature review. Most reported cases were treated with CSF diversion or reoperation. There were a total of 4 cases previously reported with successful nonoperative management. Of these cases, only 1 case was reported in the pediatric population. CONCLUSIONS: De novo hydrocephalus, in association with subdural hygromas following CM-I decompression, is rare. This presentation suggests that these complications after posterior fossa decompression with duraplasty can be treated with nonoperative medical management, therefore obviating the need for CSF diversion or reoperation. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/30028271/Management_of_hydrocephalus_and_subdural_hygromas_in_pediatric_patients_after_decompression_of_Chiari_malformation_type_I:_case_series_and_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -