British Paediatric Association

JOHN LORBER (Sheffield). 'Long-term Prognosis of Subdural Effusions in Infancy.' Of 37 consecutive infants suffering from post-traumatic subdural effusions, 34 survived with an average period of observation of 3 years. There were 28 boys. The technique of management consisted of repeated aspirations until the effusions dried up. This was the only treatment necessary in 19 infants, 11 of whom recovered without sequelae. In 13 infants the effusions failed to clear by this method, and in these a Holter shunt was put into the subdural space draining it into the right auricle. This was satisfactory in 10 infants, and the shunt could be subsequently removed, and 7 of these are normal. Removal of the membrane was only carried out in 7 infants. The indications were based on Ingraham and Matson's earlier observations, but retrospectively these seemed to be inadequate. No child benefited from such a procedure. Altogether 19 survivorsare physically and mentallynormal. 4 are moderately handicapped, but 11 are severely handicapped, both intellectuallyand byphysical sequelae. The physical sequelae consist of blindness, spasticity, and convulsions in almost all children. These gross handicaps were not due to the persistence of the subdural effusions, but to the associated brain drainage sustained at the same time as the injury causing the effusion. Analysis of our data suggests that there is no longer adequate justification for removal of the membrane in subdural effusions, as the effusion frequently persists in spite of it, and less harrowing measures give better results.