• Vincent N Nguyen, David Wallace, Sonia Ajmera, Oluwatomi Akinduro, Lydia J Smith, Kim Giles, Brandy Vaughn, and Paul Klimo.
• Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
• Neurosurgery. 2020 Feb 1; 86 (2): 281-287.

BackgroundThe optimal management of nonacute subdural fluid collections in infantile abusive head trauma (AHT) remains controversial.ObjectiveTo review the outcomes and costs of the various treatments for symptomatic subdural fluid collections in children with AHT at a single center.MethodsOur AHT database was queried to identify children requiring any intervention for hematohygromas. Demographic, hospital course, radiologic, cost, readmission, and follow-up information were collected.ResultsFrom January 2009 to March 2018, the authors identified 318 children with AHT, of whom 210 (66%) had a subdural collection of any type (blood or cerebrospinal fluid). A total of 50 required some form of intervention specifically for chronic hematohygromas. The initial management consisted of transfontanelle percutaneous aspiration (n = 31), burr holes with (n = 12) or without (n = 3) external subdural drainage, and mini-craniotomy (n = 4). Of those who were initially managed with 1 or more needle aspiration, 23 (74%) required further intervention-12 subduroperitoneal shunts and 11 nonshunt procedures. No patient who underwent burr holes/external drainage required further intervention (n = 16). Overall, the average number of interventions needed in these 50 children for definitive treatment was 1.8 (range, 1-4). A total of 15 children ultimately required a subduroperitoneal shunt. Complications (infectious, hemorrhagic, and thrombotic) were significant and occurred in all treatment groups except burr holes without drainage (n = 3). The average hospital charge for the entire cohort was $166 300.25 (range, $19 126-$739 248).ConclusionBased on our experience to date, burr hole with controlled external subdural drainage is an effective and preferred treatment for traumatic hematohygromas; complications and need for additional intervention is low.Copyright © 2019 by the Congress of Neurological Surgeons.

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