Hematoma subdural crônico como complicação de derivações ventrículo-peritoneais

Salomão, J. Francisco; Leibinger, Renê Dottori; Lima, Yara M. Serra

doi:10.1590/S0004-282X1990000200014

Resumos

Os autores relatam sua experiência com 9 casos de derivação ventriculo-peritoneal que desenvolveram hematoma subdural crônico como complicação do procedimento. Três pacientes eram crianças, dois eram adultos com estenose do aqueduto de Sylvius e quatro, com hidrocefalia normobárica. Nos casos de hidrocefalia crônica, os hematomas foram drenados por orifício de trépano associado a oclusão temporária do catéter distal da derivação. Em dois pacientes, extremamente dependentes de válvula, optou-se por derivação subduro--peritoneal e manutenção da derivação ventrículo peritoneal original, observando-se gradual e completa reabsorção da lesão em tomografias computadorizadas de crânio seriadas. Em dois casos foi necessário trocar o sistema de drenagem por outro de pressão mais elevada. Em um caso procedeu-se a craniotomia e exérese da cápsula do hematoma para tratar coleções recidivantes. Com exceção de um paciente falecido em decorrência de complicações infecciosas, todos retornaram ao estado anterior ao desenvolvimento do hematoma.

Nine cases of chronic subdural hematoma occurring after the insertion of ventriculo-peritoneal shunts are described. Three patients were children, two were adults with stenosis of the Sylvian acqueduct, and the last four had normal pressure hydrocephalus. Patients with chronic hydrocephalus were initially treated with burr holes associated to transient occlusion of the distal catheter of the diversion in order to promote reexpansion of the compressed hemisphere. Two shunt-dependent patients were successfully treated with a concurrent subdural-peritoneal shunt. In two cases a higher pressure shunt was inserted, and in another craniotomy with membranectomy was required to treat persistent subdural fluid accumulation. One patient died due to infectious complications of multiple procedures.

J. Francisco Salomão^I; Renê Dottori Leibinger^II; Yara M. Serra Lima^III

^IChefe de Clínica do Serviço de Neurocirurgia do Hospital dos Servidores do Estado (HSE), INAMPS, RJ; Neurocirurgião da Beneficência Portuguesa, RJ

^IINeurocirurgião do HSE, INAMPS, RJ

^IIIEx-Residente do Serviço de Neurocirurgia do HSE. INAMPS, RJ

RESUMO

Os autores relatam sua experiência com 9 casos de derivação ventriculo-peritoneal que desenvolveram hematoma subdural crônico como complicação do procedimento. Três pacientes eram crianças, dois eram adultos com estenose do aqueduto de Sylvius e quatro, com hidrocefalia normobárica. Nos casos de hidrocefalia crônica, os hematomas foram drenados por orifício de trépano associado a oclusão temporária do catéter distal da derivação. Em dois pacientes, extremamente dependentes de válvula, optou-se por derivação subduro--peritoneal e manutenção da derivação ventrículo peritoneal original, observando-se gradual e completa reabsorção da lesão em tomografias computadorizadas de crânio seriadas. Em dois casos foi necessário trocar o sistema de drenagem por outro de pressão mais elevada. Em um caso procedeu-se a craniotomia e exérese da cápsula do hematoma para tratar coleções recidivantes. Com exceção de um paciente falecido em decorrência de complicações infecciosas, todos retornaram ao estado anterior ao desenvolvimento do hematoma.

SUMMARY

Nine cases of chronic subdural hematoma occurring after the insertion of ventriculo-peritoneal shunts are described. Three patients were children, two were adults with stenosis of the Sylvian acqueduct, and the last four had normal pressure hydrocephalus. Patients with chronic hydrocephalus were initially treated with burr holes associated to transient occlusion of the distal catheter of the diversion in order to promote reexpansion of the compressed hemisphere. Two shunt-dependent patients were successfully treated with a concurrent subdural-peritoneal shunt. In two cases a higher pressure shunt was inserted, and in another craniotomy with membranectomy was required to treat persistent subdural fluid accumulation. One patient died due to infectious complications of multiple procedures.

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Dr. J. Francisco Salomão - Av. N. S. Copacabana 1018/608 - 22060 Rio de Janeiro RJ - Brasil

1. Anderson FM - Subdural hematoma, a complication of operations for hydrocephalus. Pediatrics 10:11, 1952.
2. Becker DP, Nulsen FE - Control of hydrocephalus by valve-regulated venous shunt: avoidance of complications in prolonged shunt maintenance. J Neurosurg 28:215, 1968.
3. Davidoff LM, Feiring EH - Subdural hematoma occurring in surgically treated hydrocephalic chiidren: with a note on a method of handling persistent accumulations. J Neurosurg 10:557, 1953.
4. Epstein F - How to keep shunts functioning, or «the impossible dream». Clin Neurosurg 32:608, 1984.
5. Faulhauer K - The overdra ned hydrocephalus: clinical manifestations and management. In Krayenbühl H (ed): Advances and Technical Standards in Neurosurgery, Vol 9. Springer, Wien, 1982, pg 3.
6. Forrest DM, Cooper DG - Complications of ventriculo-atrial shunts. J Neurosurg 29:506, 1968.
7. Fox JL, McCullough D - The relative merits of different shunting devices. In Morley TP (ed): Current Controversies in Neurosurgery. Saunders, Philadelphia, 1976, pg 671.
8. Guidetti B, Guiffrè R, Palma L, Fontana M - Hydrocephalus in infancy and childhood: our experience of CSF shunting. Child's Brain 2:209, 1976.
9 Horwitz AB, Rizzoli HV - Postoperative complications in Neurosurgical Practice: Recognition, Prevention and Management. Williams and Wilkins, Baltimore, 1967, pg 207.
10. Hughes CP, Siegel BA, Coxe WS, Gado MH, Grubb RL, Codeman RE, Berg I, - Adult idiopathic communicating hydrocephahlus with and without shunting. J Neurol Neurosurg Psychiat 41:961, 1978.
11. Illingworth RD - Subdural haematoma after the treatment of chronic hydrocephalus by ventriculocaval shunts. J Neurol Neurosurg Psychiat 33:95, 1970.
12. Jones R - Experience with antisiphon devices at the Prince of Wales Children's Hospital (Abstr). Child's Brain 5:555, 1979.
13. Loew F, Kivelitz R - Chronic subdural haematomas. In Vinken PJ, Bruyn GW (eds): Handbook cf Clinical Neurology, Vol. 24, Part II. North Helland Publ Co, Amsterdam, 1976, pg 297.
14. Markwalder TM - Chronic subdural hematomas: a review. J Neurosurg 54:637, 1981.
15. McCullough DC - Symptomatic progressive ventriculomegaly in hydrocephalic with patent shunts and antisiphon devices. Neurosurgery 19:617, 1986.
16. McCullough DC, Fox JL - Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma. J Neurosurg 40:372, 1974.
17. Moussa AH, Sharma SK - Subdural haematoma and the malfunctioning shunt. J Neurol Neurosurg Psychiat 41:759, 1978.
18. O'Brien M, Johnson M - Management of ventricular shunt complications. Contemporary Neurosurg 9-1, 1987.
19. Portnoy HD, Croissant PD - Combined drainage of ventricular and subdural fluid. Surg Neurol 2:41, 1974.
20. Portnoy HD, Schulte RR, Fox JL, Croissant PD, Tripp L - Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematoma. J Neurosurg 38:729, 1973.
21. Raimondi AJ, Robinson JS, Kuwamura K - Complication of ventriculo-peritoneal shunting and a critical comparison of the three-piece and one piece systems. Child's Brain 3:321. 1977.
22. Salomão JF, Leibinger RD, Lynch JC - Hematoma subdural crônico: tratamento cirúrgico e resultados em 96 pacientes operados. Arq Neuro Psiquiat (São Paulo) 48:91, 1990.
23. Samuelson S, Long DM, Chou SN - Subdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus. J Neurosurg 37:548, 1972.
24. Steinbok P, Thompson GB - Complications of ventriculo-vascular shunts: computer analysis of etiological factors. Surg Neurol 5:31, 1976.
25. Yamada H - A flow regulating device to control differential pressure in CSF shunt systems. J Neurosurg 57:570, 1982.

Hematoma subdural crônico como complicação de derivações ventrículo-peritoneais

Chronic subdural hematoma as complication of ventriculo-peritoneal shunts

Datas de Publicação

Publicação nesta coleção
25 Maio 2011
Data do Fascículo
Jun 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Anderson FM - Subdural hematoma, a complication of operations for hydrocephalus. Pediatrics 10:11, 1952.

[2] 2. Becker DP, Nulsen FE - Control of hydrocephalus by valve-regulated venous shunt: avoidance of complications in prolonged shunt maintenance. J Neurosurg 28:215, 1968.

[3] 3. Davidoff LM, Feiring EH - Subdural hematoma occurring in surgically treated hydrocephalic chiidren: with a note on a method of handling persistent accumulations. J Neurosurg 10:557, 1953.

[4] 4. Epstein F - How to keep shunts functioning, or «the impossible dream». Clin Neurosurg 32:608, 1984.

[5] 5. Faulhauer K - The overdra ned hydrocephalus: clinical manifestations and management. In Krayenbühl H (ed): Advances and Technical Standards in Neurosurgery, Vol 9. Springer, Wien, 1982, pg 3.

[6] 6. Forrest DM, Cooper DG - Complications of ventriculo-atrial shunts. J Neurosurg 29:506, 1968.

[7] 7. Fox JL, McCullough D - The relative merits of different shunting devices. In Morley TP (ed): Current Controversies in Neurosurgery. Saunders, Philadelphia, 1976, pg 671.

[8] 8. Guidetti B, Guiffrè R, Palma L, Fontana M - Hydrocephalus in infancy and childhood: our experience of CSF shunting. Child's Brain 2:209, 1976.

[9] 9 Horwitz AB, Rizzoli HV - Postoperative complications in Neurosurgical Practice: Recognition, Prevention and Management. Williams and Wilkins, Baltimore, 1967, pg 207.

[10] 10. Hughes CP, Siegel BA, Coxe WS, Gado MH, Grubb RL, Codeman RE, Berg I, - Adult idiopathic communicating hydrocephahlus with and without shunting. J Neurol Neurosurg Psychiat 41:961, 1978.

[11] 11. Illingworth RD - Subdural haematoma after the treatment of chronic hydrocephalus by ventriculocaval shunts. J Neurol Neurosurg Psychiat 33:95, 1970.

[12] 12. Jones R - Experience with antisiphon devices at the Prince of Wales Children's Hospital (Abstr). Child's Brain 5:555, 1979.

[13] 13. Loew F, Kivelitz R - Chronic subdural haematomas. In Vinken PJ, Bruyn GW (eds): Handbook cf Clinical Neurology, Vol. 24, Part II. North Helland Publ Co, Amsterdam, 1976, pg 297.

[14] 14. Markwalder TM - Chronic subdural hematomas: a review. J Neurosurg 54:637, 1981.

[15] 15. McCullough DC - Symptomatic progressive ventriculomegaly in hydrocephalic with patent shunts and antisiphon devices. Neurosurgery 19:617, 1986.

[16] 16. McCullough DC, Fox JL - Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma. J Neurosurg 40:372, 1974.

[17] 17. Moussa AH, Sharma SK - Subdural haematoma and the malfunctioning shunt. J Neurol Neurosurg Psychiat 41:759, 1978.

[18] 18. O'Brien M, Johnson M - Management of ventricular shunt complications. Contemporary Neurosurg 9-1, 1987.

[19] 19. Portnoy HD, Croissant PD - Combined drainage of ventricular and subdural fluid. Surg Neurol 2:41, 1974.

[20] 20. Portnoy HD, Schulte RR, Fox JL, Croissant PD, Tripp L - Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematoma. J Neurosurg 38:729, 1973.

[21] 21. Raimondi AJ, Robinson JS, Kuwamura K - Complication of ventriculo-peritoneal shunting and a critical comparison of the three-piece and one piece systems. Child's Brain 3:321. 1977.

[22] 22. Salomão JF, Leibinger RD, Lynch JC - Hematoma subdural crônico: tratamento cirúrgico e resultados em 96 pacientes operados. Arq Neuro Psiquiat (São Paulo) 48:91, 1990.

[23] 23. Samuelson S, Long DM, Chou SN - Subdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus. J Neurosurg 37:548, 1972.

[24] 24. Steinbok P, Thompson GB - Complications of ventriculo-vascular shunts: computer analysis of etiological factors. Surg Neurol 5:31, 1976.

[25] 25. Yamada H - A flow regulating device to control differential pressure in CSF shunt systems. J Neurosurg 57:570, 1982.