Hemicraniectomy in the management of acute subdural hematoma

1971 ◽  
Vol 34 (1) ◽  
pp. 70-76 ◽  
Author(s):  
Joseph Ransohoff ◽  
M. Vallo Benjamin ◽  
E. Lyle Gage ◽  
Fred Epstein

✓ Acute subdural hematomas requiring surgical drainage as a life-saving procedure shortly after injury have been associated with mortality rates as high as 90%. Important factors include early diagnosis, complete clot removal, control of active bleeding, and provision for control of subsequent cerebral edema. In a series of 35 patients who had large, unilateral acute subdural hematomas and were unconscious and decerebrate, the mortality rate was reduced to 60%, and 28% returned to normal activity, through the use of a radical procedure. Following establishment of airway and intravenous Mannitol, emergency angiography was carried out to demonstrate the exact intracranial pathology. A hemicranial bone flap was utilized to aid in clot removal and control of hemorrhage from bridging veins and/or cerebral lacerations. The bone flaps were discarded and the dura not closed to afford postoperative decompression. Plating of the skull defects was carried out at a later date when indicated.

1982 ◽  
Vol 57 (2) ◽  
pp. 254-257 ◽  
Author(s):  
Henry A. Shenkin

✓ In a consecutive series of 39 cases of acute subdural hematoma (SDH), encountered since computerized tomography diagnosis became available, 61.5% were found to be the result of bleeding from a small cortical artery, 25.6% were of venous origin, 7.7% resulted from cerebral contusions, and 5% were acute bleeds into chronic subdural hematomas. Craniotomy was performed promptly on admission, but there was no difference in survival (overall 51.3%) between patients with arterial and venous bleeds. The only apparent factor affecting survival in this series was the preoperative neurological status: 67% of patients who were decerebrate and had fixed pupils prior to operation died. Of patients with less severe neurological dysfunction, only 20% failed to survive.


2005 ◽  
Vol 102 (6) ◽  
pp. 1130-1132 ◽  
Author(s):  
Alessio Albanese ◽  
Antonio Tuttolomondo ◽  
Carmelo Anile ◽  
Giovanni Sabatino ◽  
Angelo Pompucci ◽  
...  

✓ Chronic subdural hematomas (SDHs) generally occur in elderly patients. Its pathogenesis is usually related to head trauma with tearing and rupture of the bridging veins, although in some cases a history of trauma is not recognizable. There are many reports regarding the association between spontaneous chronic SDHs and an alteration in coagulative parameters. A coagulative disorder should be suspected when an unexplained hemorrhage occurs, especially in a young patient. The authors report on three young men with a deficiency in coagulation factor XIII (FXIII) who underwent surgery for chronic SDHs. The role of FXIII in the pathogenesis of chronic SDH is emphasized. In patients with unexplained chronic SDH all coagulation parameters and factors should be screened to identify an eventual coagulative disorder.


2020 ◽  
Vol 9 (3) ◽  
pp. 257-271
Author(s):  
Lina Gyllencreutz ◽  
Monica Rådestad ◽  
Britt-Inger Saveman

PurposeThe purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.Design/methodology/approachA Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.FindingsThree iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.Research limitations/implicationsThe experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.Practical implicationsThese statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.Originality/valueThis paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.


1978 ◽  
Vol 48 (3) ◽  
pp. 345-349 ◽  
Author(s):  
Jarl Rosenørn ◽  
Flemming Gjerris

✓ The authors present 149 patients suffering from acute (112) and subacute (37) subdural hematomas admitted during the 10-year period 1965 to 1974, with a follow-up period of 2 to 12 years. During the time of observation, 104 patients died and 45 survived; 73% of the patients with acute and 27% with subacute subdural hematomas died. Of the patients with an acute subdural hematoma, 11% went back to work, as against 32% of those with subacute subdural hematomas. The 5-year survival rate was 28% in patients with acute and 76% in patients with subacute subdural hematomas.


1974 ◽  
Vol 41 (4) ◽  
pp. 435-439 ◽  
Author(s):  
Paul K. O'Brien ◽  
John W. Norris ◽  
Charles H. Tator

✓ Five cases of acute subdural hematoma associated with bleeding from cortical arteries are described. In the four cases in which the affected vessel was examined histologically, there was a defect in the arterial wall secondary to avulsion of a small surface twig, which had apparently been traversing the subdural space. The possible mechanisms for damage to the vessel wall and the role of this arterial bleeding in subdural hematomas are discussed.


2014 ◽  
Vol 26 (3) ◽  
pp. 218-237
Author(s):  
Erik B. Nes

Purpose – What characterizes the relationships with intermediaries that are soon to be replaced, and are the replacements successful? The paper aims to discuss these issues. Design/methodology/approach – The study applies a longitudinal design. The paper conducted a survey among a sample of exporters concerning their relationships with independent intermediaries in terms of trust, commitment, communication, control and two performance variables; financial performance and strategic goal achievement. Five years thereafter the author contacted the same companies again and questioned which independent intermediaries had been replaced in the period. The author then compared the replaced intermediaries with the extended intermediaries before they were replaced and analysed changes in the evaluations of the relationships and of the performance after the replacement. Findings – The relationships with terminated intermediaries that were replaced by sales subsidiary or home-based direct sales were characterized having higher trust, communication and control than extended relationships before replacement. While it may be surprising that these quite successful relationships were terminated, this is in line with internationalization process theories. The replacements, both intermediaries that were replaced by other intermediaries and by sales subsidiary/home-based direct sales, were highly successful in terms of improvement in performance and behavioural relationship variables. Research limitations/implications – The empirical findings are limited by the sample and by data collection from the principal only in the dyadic relations. Practical implications – International independent intermediaries should analyse the likelihood of being replaced by the principal because the relationship or the performance is unsatisfactory, but also because of satisfactory evaluations. Terminations of satisfactory relationships tend to be accompanied by change in operation mode to internal organization. The independent intermediary should in such cases build a defence structure against unwanted termination and/or prepare for buyout. The success of the replacements suggests that international marketers benefit from being proactive in replacing intermediaries with new intermediaries or with a hierarchal entry mode. Originality/value – This is the first study that applies most of these variables from interorganizational relations theory in the study of international independent intermediary replacements. It is also the first to give insight into the consequences of intermediary terminations.


1993 ◽  
Vol 78 (1) ◽  
pp. 126-128 ◽  
Author(s):  
Toshihiko Kuroiwa ◽  
Harushi Tanabe ◽  
Hiroyuki Takatsuka ◽  
Motohiro Arai ◽  
Nobuyoshi Sakai ◽  
...  

✓ The rapid spontaneous resolution of two traumatic acute hematomas, one extradural and one subdural, is reported in a 17-year-old young man. The authors believe that this is the first report of simultaneous resolution of both types of hematoma.


1983 ◽  
Vol 58 (2) ◽  
pp. 242-245 ◽  
Author(s):  
Bryce Weir ◽  
Philip Gordon

✓ Plasminogen, alpha2-antiplasmin, fibrinogen, fibrin degradation products (FDP's), and hemoglobin were measured in the supernatant fluid of 25 chronic subdural hematomas and five chronic subdural hygromas. The 30 patients underwent pre- and postoperative computerized tomography. The hematomas were characterized by low fibrinogen and high fibrin degradation product concentrations. The hemoglobin content varied directly with the alpha2-antiplasmin, and inversely with the plasminogen. Four patients underwent reoperation for recurrences. The initial fluid from these cases was characterized by relatively high plasminogen and low alpha2-antiplasmin. The hygromas had no hemoglobin, and low fibrinogen, high FDP's, low alpha2-antiplasmin, and variable plasminogen levels. It is possible that those cases having the greatest capacity to produce plasmin (high plasminogen and low alpha2-antiplasmin) can produce more FDP's which in turn causes more rebleeding and an increased risk of reaccumulation of chronic subdural hematomas.


1970 ◽  
Vol 33 (6) ◽  
pp. 632-635 ◽  
Author(s):  
Kenneth G. Jamieson

✓ The pattern of head injuries due to traffic accidents has changed markedly in Australia in the period since 1935. A review of autopsy cases of extradural and acute subdural hematomas shows a startling shift toward inoperable lesions. The author points out that accident prevention must now be considered the chief means of reversing man's trend toward self-destruction on the highway.


1979 ◽  
Vol 50 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Fong Y. Tsai ◽  
James E. Huprich ◽  
Hervey D. Segall ◽  
James S. Teal

✓ The authors review 29 cases of surgically-proven isodense subdural hematomas examined by non-contrast and contrast-enhanced computerized tomography scans. Three types of isodense collections were noted: homogeneous isodense collections, mixed-density collections, and gravitational layering within subdural collections. Contrast enhancement within the cerebral cortex, cortical vessels, and subdural membranes led to the correct diagnosis in each case. Contrast-enhanced scans are essential for the evaluation of isodense subdural hematomas.


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