HYDROCEPHALUS AND MACROCRANIA - SURGICAL OR NONSURGICAL TREATMENT OF POSTSHUNTING SUBDURAL-HEMATOMA

BACKGROUND Subdural hematoma is a well-known complication of hydroceph alus shunting procedures. Since the advent of modern neuroimaging tech niques, a more realistic incidence of subdural hematomas in shunted pa tients has been recognized. The description of several asymptomatic ca ses raises the problem of choosing the most appropriate therapeutic po licy for such a condition. METHODS We report two cases with long stand ing hydrocephalus and macrocrania in which bilateral huge acute and su bacute postshunting subdural hematoma developed and remained asymptoma tic. RESULTS The first patient was treated initially by surgery. Subse quently, despite the persistence of the subdural collections, a nonsur gical policy was chosen. The second patient was deliberately nonsurgic ally treated. CONCLUSIONS On the basis of our experience, we conclude that a nonsurgical policy should be followed in patients with long sta nding hydrocephalus and macrocrania, if they develop postshunting larg e hemorrhagic subdural collections and remain asymptomatic.