Severe Infantile Chronic Subdural Hematoma Treated by the Lowering of the Superior Sagittal Sinus

Two cases of severe chronic subdural hematomas of infants who were treated by “the lowering of the superior sagittal sinus (LSSS)” are reported. Case 1, an 8-month old boy, who had received a head trauma one month prior to admission was proved to have thick bilateral subdural hematomas and moderate ventricular dilatation by CT scans. He had subdural taps, two trephinations, and irrigations followed by external drainage. But the subdural hematomas remained and brain atrophy progressed. Cerebral angiography revealed the presence of thick, avascular areas over the cerebral hemispheres and stretching of the cortical bridging veins going into the superior sagittal sinus. Four months after the injury, bilateral large craniotomies, evacuation of hematomas, and lowering of the superior sagittal sinus were performed. He is now 20 months old. He has regained visual acuity, can walk with assistance by hand, and can speak simple words as well. Case 2, an 11-month old girl who had started infantile spasm at 7 months of age was found to have thick chronic subdural hematomas and remarkable brain atrophy. She was refered to our clinic at one year of age for the indication of subduro-peritoneostomy. CT scans disclosed enormously increased subdural hematoma in the left side. Bilateral large craniotomies, removal of hematomas and LSSS were performed. She is now 18 months old. She can watch and handle toys in the sitting position. It has been reported that one fourth to one fifth of infants with chronic subdural hematomas or fluid collection develop brain atrophy and severe psychomotor retardation, even with treatment by subduroperitoneal shunts. For those patients who do not respond to conventional treatments, LSSS is indicated to deminish the craniocerebral disproportion and to improve the venous return of cerebral hemispheres.