gms | German Medical Science

Objective: Treatment of non-accidental head trauma remains challenging. We analyzed our institutional SBS-cases with focus on the surgical neurological outcome.

Methods: Our electronic databank was screened for patients diagnosed with SBS. Clinical parameters, imaging findings and surgical procedures were gathered. The clinical-neurological outcome was assessed by King’s Outcome Scale for Children Head Injury (KOSCHI).

Results: Thirty-five patients were included. Main age was three months (age range 0.5 to 10 months). All patients exhibited subdural hematoma (SDH). On MRI, there was additional intraparenchymal bleeding in thirteen, traumatic subarachnoid hemorrhage in six, intraventricular bleeding in one, generalized brain edema in one, and localized cortical ischemic areas in three patients. Clinically, most children (n = 20) presented with macrocephaly (> P97). Half of the children presented with a tense fontanelle. Further, epileptic seizures, reduced alertness, and lethargy occurred frequently. In 20%, there was a need of assisted or controlled breathing. In 71% retinal bleeding and in 26% of the cases obvious signs of trauma were documented. In 38%, bony fracture was found on plain x-ray. Initial surgical treatment included drainage via burr hole (n = 9), subduro-peritoneal shunt (n = 18) and craniotomy (n= 4). Four children were treated conservertively. Regarding revisions, most cases acquired several draining procedures. In the shunt-treated group, three children needed revision due to valve-occlusion. After craniotomy, four re-operations became necessary due to recurrence of SDH. Regarding the clinical-neurological outcome, only 31% of the affected children exhibited a good and 41% a moderate recovery score (KOSCHI). Sixteen percent suffered from severe impairments, 9% exhibited apallic syndrome, and one child died due to associated severe brain injury. Concerning development of the head circumference as one further outcome measure, normalization occurred in 14/20 patients over time (< 90P, > P25). In four children, the head circumference followed P97, two children with residual brain atrophy developed microcephalic.

Conclusion: SBC is a severe condition. Surgical treatment options appear simple. However, SBS associated SDH often required several surgical procedures. Thereby, the neurological outcome seems to be more related to the primary diffuse brain injury and less to the surgical treatment paradigm.