Treatment of Subdural Hygroma

Evaluation and Diagnosis

MRI of the brain with contrast and whole spine should be performed when subdural hygroma is suspected, particularly to investigate the possibility of spontaneous intracranial hypotension (SIH) as an underlying cause 1

The treatment of subdural hygroma should be guided by the patient's symptoms and the underlying cause, with small or asymptomatic hygromas managed conservatively while treating any underlying cerebrospinal fluid (CSF) leak, and symptomatic hygromas with significant mass effect requiring surgical drainage 1, 2
Treat the underlying CSF leak as the primary management strategy for subdural hygromas associated with SIH 1, 2
Epidural blood patch (EBP) should be prioritized as initial treatment for subdural hygromas associated with SIH 1
For patients with SIH and subdural collections, refer to a specialist neuroscience center for multidisciplinary team discussion 1
Small or asymptomatic hygromas should be managed conservatively while treating the CSF leak 1
Patients should be advised to maintain bed rest in supine position as much as possible 1
For symptomatic hygromas with significant mass effect, burr hole drainage should be performed in conjunction with treating any underlying CSF leak 1

For patients who have undergone EBP for SIH-related subdural hygromas, maintain supine position with head elevated as comfortable 1
Consider thromboprophylaxis during immobilization 1
Clinical review prior to discharge and follow-up the next day 1
Advise patients to lie flat as much as possible for 1-3 days after procedure 2
Minimize bending, straining, stretching, and other activities for 4-6 weeks 2