Bedside transfontanelle drain placement reduces the need for operative intervention in infants with subdural fluid collections.

Autor: Pazniokas J; Department of Neurosurgery, University of Colorado, Aurora, CO, USA. Julia.pazniokas@cuanschutz.edu., Harris W; Department of Neurosurgery, University of Colorado, Aurora, CO, USA., Alshareef M; Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA., Alexander AL; Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA., Hankinson TC; Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA., Handler MH; Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA., Wilkinson CC; Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA., Samples DC; Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA.
Jazyk: angličtina
Zdroj: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2024 Dec 16; Vol. 41 (1), pp. 55. Date of Electronic Publication: 2024 Dec 16.
DOI: 10.1007/s00381-024-06712-1
Abstrakt: Objective: Subdural fluid collection is a common neurosurgical condition in the pediatric population. Patients requiring surgical intervention have historically been managed with subdural drains, subdural-subgaleal shunting, subdural-peritoneal shunting, and mini-craniotomies. An alternative procedure for patients with an open anterior fontanelle is bedside transfontanelle drainage. This study aims to evaluate the efficacy of the transfontanelle angiocatheter drain placement including complications and the need for any further surgery.
Methods: We performed a single-center retrospective review of all patients who underwent placement of transfontanelle drain to treat subdural fluid collections from January 2013 to June 2023. Data points collected included demographics, comorbidities, mechanism of subdural collection, neurologic status on presentation, subdural size, amount of drainage, complications, and need for further intervention.
Results: We identified 28 patients who underwent bedside transfontanelle subdural angiocatheter placement between January 2013 and June 2023. The patient age range was 0-11 months (avg 3.96). Twenty-three patients were male (82%). Nineteen patients (68%) had new seizures on presentation or during hospitalization. Eighteen patients (64%) suffered non-accidental trauma. The subdural on the side of the drainage ranged from 4 to 18 mm in size. On average, a total of 590 mL (22-1648) of fluid was drained over 3.5 (1-9) days. One medically complex patient on aspirin for cardiac comorbidities had post-procedural complication of new hemorrhage and one patient developed meningitis. Nineteen patients did not require any further treatment. Six patients underwent subsequent subdural-peritoneal shunting, two required subsequent placement of surgical subdural drains, and one underwent bilateral burr hole craniotomies with subdural drain placement. Patients who suffered NAT were more likely to not need further intervention than those with other mechanisms of subdural fluid collections.
Conclusions: This retrospective review demonstrates that bedside transfontanelle drain placement is an effective practice to reduce the need for operative intervention in infants with an open anterior fontanelle. The procedure can be performed expeditiously in the emergency room, ICU, or floor setting without the need for general anesthesia. While future larger prospective studies are warranted, our series documented this practice to be performed safely.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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