Outcome of surgical treatment for subdural fluid collections in infants

We reviewed retrospectively the management of 47 infants with subdural coll ections at the Birmingham Children's Hospital. Of those patients who had ne edle aspiration as their initial treatment 42% required some form of furthe r treatment and 25% were complicated by infection of the subdural collectio n. Of those patients treated with burr hole evacuation or with observation alone, 78 and 73%, respectively, required no further procedures. However, 1 7% of those who had burr holes as their initial treatment developed post-op erative infected collections. Of those who had subdural-peritoneal shunt as initial or subsequent treatment, none required further procedures to treat the subdural collections. No infections were noted following shunting. The re was no statistically significant difference in overall clinical outcome at last follow-up between the different treatment groups. We conclude that needle aspirations should be avoided due to high infection risk, and that o bservation alone can be sufficient in the absence of intracranial hypertens ion, as the condition may be self-limiting. In cases requiring surgery, it should be borne in mind that burr hole evacuation has a higher infection ri sk, whereas subdural shunting has the additional need for removal of the de vice if the parents and surgeon decide accordingly. Copyright (C) 2000 S. K arger AG, Basel.