Subdural

This is a similar procedure to the ventricular tap discussed above and once again relies on an open fontanelle.

Indications

Subdural hygroma or chronic hematoma over a cerebral convexity.

Contraindications

1. Acute hematoma. Solid clot is virtually impossible to remove through a small needle.

2. Coagulopathy.

Procedure

The point of entry is ipsilateral to the fluid collection and, as with the ventricular tap, is in the lateral corner of the anterior fontanelle. A 20-gauge angiocatheter is used. Occasionally, after puncture, fluid may continue to ooze from the site. One should stagger the puncture points of the skin and dura as described above. Bilateral taps are necessary for bilateral collections.

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