Subdural Hematoma after Shunt Operations

Among aseries of 388 shunt operations, subdual hematoma occurred in 8 cases (2.1%). It occurred in both children and adults, in 5 low- and 3 medium-pressure shunt systems, on the ipsilateral and contralateral sides to a ventriculo-peritoneal shunt in 3 and 4 casea, respectively, and 1 in a lumbo-peritoneal shunt. Preceding subdural effusion was noted in 7 cases. Symptoms,duration and character of the hematoma were similar to those of chronic subdural hematoma. Symptoms tended to be rather mild and were compensated by a shunt system. Furthermore, removal of the hematoma in three cases required additional procedures such as ligation of the shunt, replacement to a higher-pressure valve or a subdural-peritoneal shunt for reexpansion of the brain. One case of cranio-cerebral disproportion required the reduction cranioplasty for prevention of hematoma recurrence. Promting factors were thought to be low intracranial pressure resulted from the shunt system or the pumping valve, head and individual anatomical susceptibility. Subdural effusion after a shunt operation should be regarded as a warning sign, and precautions should be taken against occurrence of chronic subdural hematoma. To prevent this complication, addition of an anti-siphon device is recommended.

Subdural hematoma

Subdural effusion

Shunt opration

Hydrocephalus

Intracranial pressure