Color Doppler ultrasound of subscalp effusion

During the color ultrasound examination, if fluid is found under the scalp, this may be due to subdural effusion. No matter which type of effusion it is, it is necessary to find out the cause before symptomatic treatment can be given. Conservative treatment can be carried out, such as traditional Chinese medicine to improve brain microcirculation. Some other Western medicines also have good effects. If the condition is severe, surgery can be used to treat it.

Color Doppler ultrasound of subscalp effusion

Is the effusion subdural effusion? But no matter where the fluid accumulates in the brain, a small amount will not cause obvious headache, so we need to find out whether the headache is related to subdural effusion.

Small amounts of subdural effusion can be temporarily treated conservatively by taking some Chinese medicine that promotes blood circulation, removes blood stasis, improves cerebral microcirculation, and Western medicine that promotes brain cell metabolism. These medicines are also helpful for cerebral atrophy, but you must regularly check the head CT scan every 2-3 months. If the headache worsens or symptoms such as drowsiness and inflexibility of one side of the limbs appear, see a doctor immediately because the amount of chronic subdural effusion may increase in the elderly.

Treatment

1. Non-surgical treatment:

1. Use dehydrating agents with caution or not at all to avoid excessive hypotension leading to increased fluid accumulation.

2. Use neurotrophic drugs, cerebral vasodilators, drugs that inhibit cerebrospinal fluid secretion, hyperbaric oxygen therapy, etc. to improve cerebral blood circulation and metabolism, and provide the possibility of reducing the subdural space by repositioning the bulge of brain tissue.

Second surgical treatment:

A. Principles:

① Eliminate brain pressure caused by fluid accumulation;

② Eliminate the cause of effusion;

③ Eliminate the cystic cavity with fluid accumulation.

Only by complying with the above three surgical principles can we fundamentally prevent the recurrence of effusion and achieve the goal of complete cure.

B. Indications for surgery:

① For patients with clinical symptoms of nervous system compression or epileptic seizures, surgery should be performed to remove the effusion and relieve the compression regardless of the amount of effusion.

② If the amount of supratentorial effusion is >25ml and the amount of infratentorial effusion is >8ml, surgical treatment should be adopted to facilitate recovery even if there is no compression of the nervous system.

③ The space-occupying effect is severe, with obvious symptoms of intracranial hypertension. Imaging examinations (CT or MRI) show compression and deformation of the ventricles and cisterns, and a midline shift of >10 mm.

④ Infants and young children whose frontal space is larger than 6mm.

C. Surgical method:

①Puncture and drainage.

② For patients with patent anterior fontanelle, a No. 7 common venous cannula needle is used to perform percutaneous puncture at the lateral angle of the anterior fontanelle for continuous drainage.

③ For patients with intracranial hematoma, severe cerebral contusion and laceration, and signs of brain herniation, craniotomy should be performed as soon as possible to remove the hematoma and effusion, and the bone craniotomy should be performed to decompress the patient.

④ Intracorporeal shunt: Although clinical symptoms improve after extracorporeal drainage, the fluid accumulation does not decrease, or the fluid accumulation increases or the clinical symptoms worsen after the drainage tube is removed.

D. The effect of surgery is:

① After drainage, the intracranial pressure is effectively reduced, blocking the vicious cycle of enhanced pulsatility caused by intracranial hypertension.

② Removes liquids with high protein content that are not easily absorbed.

③ Subdural drainage helps the exudate of brain tissue flow out of the surface of the brain without infiltrating into the tissue spaces to cause or aggravate cerebral edema.

2. Prevent brain damage: The drainage tube should be strictly oriented toward the dura mater and should not be attached to the brain tissue to avoid damaging the brain tissue during intubation or removal of the tube.

3. After the operation, it is important to supplement isotonic fluid, raise the drainage tube by 15 cm, maintain normal intracranial pressure, and lie flat or lower the head when necessary to facilitate the repositioning of brain tissue.