Postoperative contralateral subdural effusion (CSE) is an uncommon but clinically significant complication that may occur after neurosurgical procedures, especially decompressive craniotomy or tumor resection. It results from altered cerebrospinal fluid (CSF) dynamics and pressure gradients.
Postoperative contralateral subdural effusion, is a serious complication secondary to decompressive craniectomy in patients with head trauma.
Yang et al. confirmed that postoperative contralateral subdural effusion was not an uncommon complication secondary to decompressive craniectomy. Most contralateral subdural effusions resolved spontaneously after conservative management, but surgical management may be necessary if the patients develop deteriorating clinical manifestations or the subdural effusion has an apparent mass effect 1).
CSDSE occurs due to:
- Pressure Gradient Alterations: The removal of a bone flap disrupts the normal intracranial pressure balance, potentially leading to a shift of CSF and fluid collection in the contralateral subdural space.
- CSF Leakage or Malabsorption: Altered CSF dynamics post-DC can result in impaired CSF reabsorption, leading to fluid accumulation.
- Brain Shift and Dural Separation: The decompressed brain may shift toward the craniectomy defect, creating a potential space on the opposite side where CSF or blood can accumulate.
Postoperative CSE is a manageable complication with appropriate risk assessment, intraoperative precautions, and postoperative monitoring. Awareness of the mechanisms can aid in early detection and intervention, preventing potential complications.