Cranioplasty for postoperative contralateral subdural effusion treatment [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Cranioplasty for postoperative contralateral subdural effusion treatment ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1JUQiFFHYgOtKznv_cHBgGzb8bzi9n9Utht_PQHWIG9U6uQwMe/?limit=15&utm_campaign=pubmed-2&fc=20250318144300}}
----
see [[Postoperative contralateral subdural effusion treatment]]
----
Cranioplasty, traditionally performed to restore cranial integrity and improve neurological function, has demonstrated effectiveness in resolving persistent CSDSE by:

1. **Restoring [[Intracranial Pressure]] [[Homeostasis]]**: Cranioplasty reduces the abnormal pressure gradient that contributes to the effusion.

2. **Reversing Brain Shift**: The replacement of the bone flap or implantation of an artificial cranial implant facilitates the re-expansion of the brain, reducing the subdural potential space.

3. **Improving CSF Dynamics**: By normalizing intracranial compliance, CSF circulation and absorption improve, potentially leading to spontaneous resolution of the effusion.

====== Indications ======

- **Symptomatic CSDSE**: Persistent [[headache]], altered mental status, or signs of increased [[intracranial pressure]].

- **Progressive or Large Subdural Effusion**: Radiological worsening despite conservative measures.

- **Failure of Conservative Management**: When observation or CSF diversion (e.g., [[lumbar drainage]] or shunting) does not lead to resolution.

- **Delayed Neurological Recovery**: Some patients experience cognitive or motor deficits attributed to the altered intracranial environment, which may improve following [[cranioplasty]].

====== Surgical Considerations and Timing ======

- **Optimal Timing**: Early cranioplasty (within 3 months post-DC) may be beneficial for selected patients with persistent CSDSE, though individualized assessment is necessary.

- **Materials Used**: Autologous bone, polymethylmethacrylate (PMMA), titanium, or 3D-printed implants are options based on patient-specific factors.

- **Perioperative Management**: Careful monitoring of intracranial pressure, avoidance of excessive brain retraction, and consideration of CSF drainage methods during surgery.

====== Outcomes and Prognosis ======

- **Resolution of CSDSE**: Many studies report that cranioplasty results in a significant reduction or complete resolution of the effusion.

- **Neurological Improvement**: Some patients experience cognitive and motor recovery post-cranioplasty.

- **Risk of Complications**: While beneficial, cranioplasty carries risks such as infection, hematoma, or hydrocephalus, necessitating careful patient selection and perioperative management.


----
Cranioplasty is an effective treatment for postoperative contralateral subdural effusion, particularly in symptomatic or progressive cases. By restoring intracranial pressure homeostasis, reversing brain shift, and improving CSF dynamics, cranioplasty not only resolves effusions but may also enhance neurological recovery. Future studies should focus on optimizing timing and identifying predictive factors for improved patient outcomes.
----



Early cranioplasty should be performed for patients with CSEDC. CSF shunting procedures may be required for patients in whom CSEDC have not been solved or hydrocephalus manifest after cranioplasty
((Ling H, Yang L, Huang Z, Zhang B, Dou Z, Wu J, Jin T, Sun C, Zheng J. Contralateral subdural effusion after decompressive craniectomy: What is the optimal treatment? Clin Neurol Neurosurg. 2021 Nov;210:106950. doi: 10.1016/j.clineuro.2021.106950. Epub 2021 Sep 17. PMID: 34583274.))
----
In cases of [[decompressive craniectomy]], early [[cranioplasty]] is an effective, economical, and less painful treatment
((Wan Y, Shi L, Wang Z, Sun G, Pan T, Zhang S, Zeng Y. Effective treatment via
early cranioplasty for intractable contralateral subdural effusion after standard
decompressive craniectomy in patients with severe traumatic brain injury. Clin
Neurol Neurosurg. 2016 Oct;149:87-93. doi: 10.1016/j.clineuro.2016.08.004. Epub
2016 Aug 2. PubMed PMID: 27500656.
))

Zhu et al., describes a new method following Ommaya reservoir implantation, a patient with contralateral progressive TSH secondary to decompressive craniectomy after traumatic brain injury made a good postoperative recovery
((Zhu L, Chu S, Feng DF. Ommaya reservoir implantation for the treatment of
contralateral progressive traumatic subdural effusion secondary to decompressive 
craniectomy: a case report. Br J Neurosurg. 2016 Sep 14:1-2. [Epub ahead of
print] PubMed PMID: 27623962.
)).

===== Reviews =====
A PubMed, Web of Science, and Google Scholar search was conducted for preferred reporting items following the guidelines of systematic review and meta-analysis, including studies reporting patients who underwent cranioplasty because of CSEDC.

The search yielded 8 articles. A total of 56 patients ranging in age from 21 to 71 years developed CSEDC. Of them, 32 patients underwent cranioplasty. Eighteen cases with symptomatic CSE underwent cranioplasty alone, 2 cases received Ommaya drainage later because of a recurrence of CDC, and 1 case underwent a ventriculoperitoneal shunt because the CSE did not resolve completely and the ventricle was dilated again. The symptoms of 14 cases lessened without recurrence after simultaneous cranioplasty and drainage or a shunt. The total success rate (CSE disappeared without recurrence) was 90.6% for patients who underwent cranioplasty; however, the total incidence of hydrocephalus was 40.1%.

This review suggests that cranioplasty is effective for the treatment of CSEDC, particularly intractable cases, but early cranioplasty may be more effective. In addition, hydrocephalus is fairly common after cranioplasty and requires further treatment
((Zhou W, Wang Z, Zhu H, Xie Z, Zhao Y, Li C, Xie S, Luo J, Li M, Yao J. Effects of Cranioplasty on Contralateral Subdural Effusion After Decompressive Craniectomy: A Literature Review. World Neurosurg. 2022 Sep;165:147-153. doi: 10.1016/j.wneu.2022.06.117. Epub 2022 Jun 30. PMID: 35779748.)).


===== Case reports =====

[[Cranioplasty for postoperative contralateral subdural effusion treatment case reports]]