Subdural effusion

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Subdural pathology

Numbers

• Occurs in 40-60% of infants and young children with proven meningitis.

Management

Conservative

• Indication
• Small collections

• Generally subside with observation alone

Surgical drainage

• Indication
• Symptomatic
• Causing mass effect.

• Options
• Serial percutaneous needle drainage,
• Burr hole drainage,
• External subdural drain
• Indication
• Fluid was purulent
• When the collection was estimated to be too large to be cured with SDP alone
• When raised ICP recurred after SDP
• Used for 1-2 weeks until fluid becomes clearer → SDP
• Subduroperitoneal shunt (SDP).

• Removal of internal subdural shunts should ideally be after a few months.

Craniotomy for membrane excision

• In rare cases of obstruction of the drainage associated with thick subdural membranes exerting a mass effect on the brain, craniotomy with membrane resection can be performed.