Role of surgical modality and timing of surgery as clinical outcome predictors following acute subdural hematoma evacuation

Background & Objective: A Craniotomy (CO) or decompressive craniectomy (DC) are the two main surgical procedures employed for evacuation of acute traumatic subdural hematoma (ASDH). However, the optimal surgical procedure remains controversial. The beneficial effect of early surgical evacuation of acute subdural hematoma in improving outcome also remains unclear. Our objective was to study the role of these two parameters in determining the outcome in patients undergoing surgical evacuation of acute traumatic subdural hematoma. Methods: A retrospective analysis of 58 patients presenting with acute traumatic subdural hematoma and with presenting Glasgow Coma Scale (GCS) ≤ 8 that had been operated in Lahore General Hospital between June 2014 and July 2015 was performed. The demographic data, preoperative GCS, type of surgical procedure performed and timing of surgery were analysed. Results: Forty (69%) patients underwent CO, and eighteen (31%) patients underwent DC. The CO and DC groups showed no difference in the demographic data and preoperative GCS. Six patients survived in the craniotomy group, while none survived in the decompressive craniectomy group (p=0.083). The relationship of timing of surgery with survival in the craniotomy group was found not to be clinically significant (p=0.87). Conclusion: In this study craniotomy was associated with a better outcome as compared to decompressive craniectomy, however, the difference did not reach statistical significance. Early surgery was also found not to be associated with an improved outcome. doi: https://doi.org/10.12669/pjms.36.3.1771 How to cite this:Altaf I, Shams S, Vohra AH. Role of surgical modality and timing of surgery as clinical outcome predictors following acute subdural hematoma evacuation. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1771 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comparison of Craniotomy and Decompressive Craniectomy in Severely Head-Injured Patients With Acute Subdural Hematoma

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2012.05.062 ◽

2012 ◽

Vol 2012 ◽

pp. 316-318

Author(s):

B.T. Ragel ◽

A.M. Raslan

Keyword(s):

Decompressive Craniectomy ◽

Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Head Injured ◽

Injured Patients

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Clinical Characteristics and Surgical Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage and Acute Subdural Hematoma Undergoing Decompressive Craniectomy

World Neurosurgery ◽

10.1016/j.wneu.2010.10.021 ◽

2011 ◽

Vol 75 (1) ◽

pp. 73-77 ◽

Cited By ~ 14

Author(s):

Naoki Otani ◽

Yoshio Takasato ◽

Hiroyuki Masaoka ◽

Takanori Hayakawa ◽

Yoshikazu Yoshino ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Decompressive Craniectomy ◽

Subdural Hematoma ◽

Surgical Outcomes ◽

Clinical Characteristics ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Acute Subdural Hematoma

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ROLE OF DECOMPRESSIVE CRANIECTOMY IN PATIENTS WITH TRAUMATIC INTRACRANIAL HEMATOMAS.

10.36106/ijsr/5937880 ◽

2020 ◽

pp. 1-2

Author(s):

Amar Nath

Keyword(s):

Clinical Outcome ◽

Decompressive Craniectomy ◽

Negative Impact ◽

Secondary Injury ◽

Raised Intracranial Pressure ◽

Significant Extent ◽

Decompressive Craniotomy ◽

Intracranial Hematomas ◽

Second Procedure

Aim – The study done to evaluate the role of decompressive craniectomy in patients with traumatic intracranial hematomas. Introduction - Although decompressive craniectomy for traumatic brain injury is very effective procedure in patients with raised intracranial pressure refractory to medical measures, its effect on clinical outcome is still unclear because of both positive as well as negative impact of procedure. As after decompressive craniectomy, clinical outcome becomes mainly dependent on primary head injury as secondary injury is prevented by decompressive craniectomy and beneficial effect of decompressive craniectomy is partially neutralized by complications associated with it to a small but significant extent. Patients and method - we retrospectively analysed 72 patients operated in last five years for traumatic intracranial hematomas by decompressive craniotomy. We followed practice of large craniotomy and evacuation of hematomas in last five years in properly selected patients and reserving craniectomy as second procedure in patients in whom patient did not improve radiologically/clinically after craniotomy. Results - In 61 out of 72 patients operated by decompressive craniotomy, there has been significant improvement in GCS of patients and none of patients needed decompressive craniectomy.

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Intracranial Acute Subdural Hematoma Following Spinal Anesthesia: Our Experience with Six Patients

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685184 ◽

2019 ◽

Vol 81 (01) ◽

pp. 044-047

Author(s):

Ahmed M. Elshanawany ◽

Amani Hassan Abdel Wahab

Keyword(s):

Spinal Anesthesia ◽

Subdural Hematoma ◽

Time Lag ◽

Acute Subdural Hematoma ◽

Etiological Factors ◽

Blood Disorder ◽

Surgical Evacuation ◽

Persistent Headache ◽

Severe Deterioration

Abstract Objective To describe our experience with the occurrence of intracranial acute subdural hematoma (ASDH) following spinal anesthesia. Patients and Methods We reviewed our records from 2010 to 2017 to detect cases of nontraumatic ASDH following spinal anesthesia. All cases were analyzed for the etiological factors, time lag between the procedure and hematoma diagnosis, treatment, and outcome. Results Of 329 cases of nontraumatic ASDH, we identified 6 patients whose spontaneous ASDH developed following spinal anesthesia. All our patients were obstetrical and received spinal anesthesia for delivery. Patient ages ranged from 21 to 34 years. Two patients presented with deterioration of consciousness a few hours after delivery. Three patients presented with persistent headache and lethargy days after delivery. One patient presented 3 days after delivery with severe deterioration of consciousness. All patients had undergone surgical evacuation of a hematoma. Five patients recovered and one patient died 2 days after surgery. Records showed none of the six patients had coagulopathy or any other blood disorder. Conclusion Although uncommon, intracranial ASDH should be considered in patients following spinal anesthesia, especially those with a prolonged headache after the procedure.

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Predictors of subacute hematoma expansion requiring surgical evacuation after initial conservative treatment in patients with acute subdural hematoma

Acta Neurochirurgica ◽

10.1007/s00701-019-04187-7 ◽

2019 ◽

Vol 162 (2) ◽

pp. 357-363 ◽

Cited By ~ 4

Author(s):

Tomomichi Kayahara ◽

Yuichiro Kikkawa ◽

Hiroyuki Komine ◽

Tomoya Kamide ◽

Kaima Suzuki ◽

...

Keyword(s):

Conservative Treatment ◽

Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Hematoma Expansion ◽

Surgical Evacuation

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Does the skull Hounsfield unit predict shunt dependent hydrocephalus after decompressive craniectomy for traumatic acute subdural hematoma?

PLoS ONE ◽

10.1371/journal.pone.0232631 ◽

2020 ◽

Vol 15 (4) ◽

pp. e0232631

Author(s):

In-Suk Bae ◽

Jae Min Kim ◽

Jin Hwan Cheong ◽

Je Il Ryu ◽

Kyu-Sun Choi ◽

...

Keyword(s):

Decompressive Craniectomy ◽

Subdural Hematoma ◽

Hounsfield Unit ◽

Acute Subdural Hematoma

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P.082 Traumatic inter hemispheric subdural hematomas – clinical presentation, management and outcome

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.186 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S39-S40

Author(s):

R Bokari ◽

S Schur ◽

C Couturier ◽

A Al-Azri ◽

J Marcoux ◽

...

Keyword(s):

Clinical Outcome ◽

Conservative Management ◽

Subdural Hematoma ◽

Trauma Center ◽

Complete Resolution ◽

Clinical Presentation ◽

Acute Subdural Hematoma ◽

Detailed Review ◽

Subdural Hematomas ◽

Level I

Background: There is currently little data on the incidence, clinical outcome and management of traumatic interhemispheric subdural hematomas (IHSDHs). Methods: All patients admitted with an acute subdural hematoma (SDH) over a 5-year period at a Level I trauma center were included. A detailed review of all cases of large IHSDH (≥7 mm) was performed to document clinical presentation, management and outcomes. Results: Of 1182 patients with acute subdural hematomas (SDHs), 420 had IHSDHs (24%), and 50 were large IHSDHs. For patients with large IHSDH, the average age was 76 years (±11) and 44% were female. The average GCS was 12 on presentation (±4), and the average GOSE was 4 (±2). 66% of patients had associated cranial/ intracranial injuries (fracture, subarachnoid/epidural/SDH) and 26% required operations for acute convexity SDH. Three patients required operations for their IHSDH by inter hemispheric approach. By 10 weeks, 82% had a complete resolution of the IHSDHs. Conclusions: IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is often appropriate to manage even large IHSDHs, as most resolve spontaneously. This study will help document the occurrence of falx syndrome, as well as the management and outcomes of larger IHSDHs.

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