What is the treatment for subdural hygroma?

Treatment of Subdural Hygroma

The treatment of subdural hygroma should be guided by the patient's symptoms and the underlying cause, with small or asymptomatic hygromas managed conservatively while treating any underlying cerebrospinal fluid (CSF) leak, and symptomatic hygromas with significant mass effect requiring surgical drainage. 1

Evaluation and Diagnosis

• MRI of the brain with contrast and whole spine should be performed when subdural hygroma is suspected, particularly to investigate the possibility of spontaneous intracranial hypotension (SIH) as an underlying cause 1
• CT scan is the preferred initial diagnostic imaging modality for traumatic subdural hygromas 2
• Careful radiological examination is essential to differentiate subdural hygroma from chronic subdural hematoma or cerebral atrophy with enlarged subarachnoid spaces 2

Treatment Algorithm Based on Etiology and Symptoms

1. Asymptomatic Subdural Hygromas

• Manage conservatively with clinical observation 3
• Most asymptomatic hygromas resolve spontaneously when the brain is well-expanded 3
• Regular follow-up imaging may be required to monitor for progression 2

2. Subdural Hygromas Associated with SIH

• Treat the underlying CSF leak as the primary management strategy 1
• Epidural blood patch (EBP) should be prioritized as initial treatment 1
• For patients with SIH and subdural collections:
  • Refer to a specialist neuroscience center for multidisciplinary team discussion 1
  • Small or asymptomatic hygromas should be managed conservatively while treating the CSF leak 1
  • Patients should be advised to maintain bed rest in supine position as much as possible 1

3. Symptomatic Subdural Hygromas with Mass Effect

• Surgical evacuation via burr hole drainage is indicated when mass effect creates neurological symptoms 2
• For symptomatic hygromas with significant mass effect, burr hole drainage should be performed in conjunction with treating any underlying CSF leak 1
• Simple burr hole irrigation rather than large craniotomy may be appropriate to reduce mass effect in many cases 4

4. Post-Decompressive Craniectomy Subdural Hygromas

• Burr hole drainage may provide only temporary relief for contralateral subdural hygromas after decompressive craniectomy 5
• Cranioplasty is considered the definitive treatment for such collections 5
• A temporary ventriculostomy or external lumbar drainage may be added to aid the cranioplasty 5

5. Spinal Subdural Hygromas

• Lumbar puncture may be an effective treatment modality for traumatic spinal subdural hygromas, potentially avoiding more invasive surgical decompression 6

Post-Treatment Management

• For patients who have undergone EBP for SIH-related subdural hygromas:
  • Maintain supine position with head elevated as comfortable 1
  • Consider thromboprophylaxis during immobilization 1
  • Clinical review prior to discharge and follow-up the next day 1
  • Advise patients to lie flat as much as possible for 1-3 days after procedure 1
  • Minimize bending, straining, stretching, and other activities for 4-6 weeks 1

Monitoring and Follow-up

• Regular clinical and radiological follow-up is essential to monitor resolution of the hygroma 3
• Be vigilant for development of chronic subdural hematoma, as some hygromas may transform into hematomas over several weeks 3
• Monitor for development of hydrocephalus, which may require CSF diversion procedures 5

Complications to Watch For

• Transformation to chronic subdural hematoma 3
• Development of hydrocephalus 5
• Cerebral venous thrombosis in cases associated with SIH 1
• Superficial siderosis in cases of persistent CSF leaks 1