Subduroperitoneal drainage for subdural hematomas in infants: results in 244 cases

Object. Subduroperitoneal drainage (SDPD) is commonly used in the treatment of infantile subdural hematomas (SDHs). Few studies have focused on this t echnique and most series have included SDHs of various origins in children of different ages. The surgical procedure is not standardized and results a chieved using this technique have not been well documented. The authors reviewed their cases of traumatic SDH treated with SDPD in infa nts (< 2 years of age). Their standard technique includes bilateral SDPD wh enever the SDH is bilateral, placement of a free shunt, and systematic remo val of the drainage unit after a few months. Methods. The authors performed SDPD in 244 infants with traumatic SDH. The patients' SDHs were controlled by SDPD in 241 cases, and 78.9% of the patie nts recovered to live a normal life. Complications of SDPD occurred in 38 p atients (15.6%): obstruction in 22 cases (9%), infection in eight cases (3. 28%), and internal hydrocephalus in eight cases (3.28%). Early complication s could be ascribed to surgical technique, delayed complications were assoc iated with the severity of the initial clinical presentation, and late comp lications were time dependent and unrelated to initial clinical severity. P oor clinical outcome was correlated to the severity of the initial presenta tion, but not to complications of surgery. Conclusions. Because of its efficacy and low complication rate, SDPD is the procedure of choice when subdural taps fail to control SDH. The authors pr efer bilateral drainage because of the low rate of complications. Drains sh ould be systematically removed after a few months to prevent long-term comp lications.