From the Guidelines
The initial management for a patient diagnosed with subdural hygroma should involve an MRI of the brain with contrast and whole spine to investigate the possibility of spinal CSF leak, and small or asymptomatic hygromas should be managed conservatively while treating the CSF leak. This approach is based on the most recent guidelines, including the multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension published in the Journal of Neurology, Neurosurgery and Psychiatry in 2023 1. The key considerations in managing subdural hygroma include:
- Investigating the underlying cause, such as a spinal CSF leak, especially in patients with a high index of suspicion, including those with orthostatic headache or without a history of trauma, coagulopathy, or alcohol misuse
- Conservative management for small or asymptomatic hygromas, focusing on treating the underlying CSF leak
- Symptomatic hygromas with significant mass effect may require burr hole drainage in conjunction with treating the leak, as recommended by the guideline 1
- Close neurological monitoring is essential to promptly identify any signs of increased intracranial pressure or neurological deterioration, which may necessitate a change in management approach.
From the Research
Initial Management for Subdural Hygroma
The initial management for a patient diagnosed with subdural hygroma can vary depending on the presence of symptoms and the underlying cause of the hygroma.
- For asymptomatic patients, conservative treatment may be sufficient, with regular monitoring of the patient's condition and serial imaging studies to assess the size and progression of the hygroma 2.
- For symptomatic patients, treatment options may include:
- Bur hole drainage: This procedure involves creating a small hole in the skull to drain the fluid accumulation in the subdural space. However, this may only provide temporary relief, and the hygroma may recur 3.
- Cranioplasty: This surgical procedure involves repairing or replacing a portion of the skull to help resolve the hygroma. Cranioplasty has been shown to be an effective treatment for symptomatic contralateral subdural hygromas after decompressive craniectomy 3.
- Shunting procedures: Subdural-peritoneal shunts or ventriculoperitoneal shunts may be used to divert the cerebrospinal fluid away from the subdural space and into the peritoneal cavity, helping to reduce the size of the hygroma 4, 5.
Considerations for Treatment
When planning treatment for subdural hygroma, it is essential to consider the underlying cause of the hygroma, as well as any potential complications or comorbidities.
- Arachnoid tears and blockage of arachnoid villi may contribute to the development of subdural hygromas, and addressing these underlying issues may be necessary to effectively manage the condition 3.
- Hydrocephalus may also be a contributing factor, and diversion procedures such as ventriculoperitoneal shunting may be required to manage this condition 3.
- The presence of mass effect or increased intracranial pressure may also influence treatment decisions, with more aggressive interventions potentially necessary to alleviate these symptoms 2.