Postoperative Contralateral Subdural Effusion Case Reports [Neurosurgery Wiki]

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====== Postoperative Contralateral Subdural Effusion Case Reports ======

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There is no [[consistent]] literature about the complications of [[hinged craniotomy]]. In particular, there are no reported cases of contralateral [[subdural effusion]] (CSE) after HC. 
Kuptsov et al. present a case of a 55-year-old man who developed CSE after a hinged craniotomy (HC) for [[intracranial hypertension]].

The subdural effusion was managed in a stepwise manner:

He showed **clinical deterioration (GCS 7)**, and imaging (CT and MRI) confirmed a **contralateral subdural effusion**.

A **burr hole drainage** was performed to relieve the effusion.

This provided **temporary relief**, but symptoms recurred within **72 hours**.

The **burr hole was reopened**, and the subdural effusion was drained again.

Additionally, the **bone flap was fixated with titanium plates** to prevent further effusion formation and restore normal intracranial pressure dynamics.

After the second surgery, the patient showed **clinical improvement** and was transferred to a **neurorehabilitation unit**
((Kuptsov A, Rocca A, Gómez-Revuelta C, Flores-Justa A, Fernández-Villa J, Nieto-Navarro JA. Contralateral subdural effusion following decompressive hinged craniotomy: A case report and narrative review. Neurocirugia (Astur : Engl Ed). 2025 Mar 14:500660. doi: 10.1016/j.neucie.2025.500660. Epub ahead of print. PMID: 40090487.)).
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A 63-year-old man experienced drowsiness (Glasgow coma scale score 13) after a fall that resulted in head trauma. Brain CT revealed a subdural haematoma at the right fronto-temporo-parietal region with a midline shift to the left. Craniectomy for evacuation of the subdural haematoma was performed immediately. A delayed intracerebral haematoma with mass effect in the right frontotemporal region developed later and was removed in a second operation. Although the patient's neurological status improved postoperatively, gradual deterioration was observed during the follow-up period. Contralateral SDG with a midline shift to the right was noted in a follow-up brain CT scan. The patient's condition improved after drainage of the SDG and he was discharged 1 week later
((Su FW, Ho JT, Wang HC. Acute contralateral subdural hygroma following craniectomy. J Clin Neurosci. 2008 Mar;15(3):305-7. doi: 10.1016/j.jocn.2006.08.019. Epub 2008 Jan 7. PMID: 18182295.))