Early Decompression of Acute Subdural Hematoma for Postoperative Neurological Improvement: A Single Center Retrospective Review of 10 Years

Overview

Journal Korean J Neurotrauma

Date 2016 May 17

PMID 27182496

Citations 6

Authors

Chang Hyun Oh

Yu Shik Shim

Seung Hwan Yoon

Dongkeun Hyun

Hyeonseon Park

Eunyoung Kim

Affiliations

Soon will be listed here.

Abstract

Objective: This study was conducted to investigate survival related factors, as well as to evaluate the effects of early decompression on acute subdural hematoma (ASDH).

Methods: We retrospectively reviewed cases of decompressive craniectomy (DC) for decade. In total, 198 cases of DC involved ASDH were available for review, and 65 cases were excluded due to missing data on onset time and a delayed operation after closed observation with medical care. Finally, 133 cases of DC with ASDH were included in this study, and various factors including the time interval between trauma onset and operation were evaluated.

Results: In the present study, survival rate after DC in patients with ASDH was shown to be related to patient age (50 years old, p=0.012), brain compression ratio (p=0.042) and brain stem compression (p=0.020). Sex, preoperative mental status, and time interval between trauma onset and operation were not related with survival rate. Among those that survived (n=78), improvements in Glasgow Coma Scale (GCS) score of more than three points, compared to preoperative measurement, were more frequently observed among the early (less than 3 hours between trauma onset and operation) decompressed cases (p=0.013). However, improvements of more than 4 or 5 points on the GCS were not affected by early decompression.

Conclusion: Early decompression of ASDH was not correlated with survival rate, but was related with neurological improvement (more than three points on the GCS). Accordingly, early decompression in ASDH, if indicated, may be of particular benefit.

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References

Xiao B, Wu F, Zhang H, Ma Y . A randomized study of urgent computed tomography-based hematoma puncture and aspiration in the emergency department and subsequent evacuation using craniectomy versus craniectomy only. J Neurosurg. 2012; 117(3):566-73. DOI: 10.3171/2012.5.JNS111611. View

Csokay A, Emelifeonwu J, Fugedi L, Valalik I, Lang J . The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series). Childs Nerv Syst. 2011; 28(3):441-4. DOI: 10.1007/s00381-011-1661-0. View

Williams R, Magnotti L, Croce M, Hargraves B, Fischer P, Schroeppel T . Impact of decompressive craniectomy on functional outcome after severe traumatic brain injury. J Trauma. 2009; 66(6):1570-4. DOI: 10.1097/TA.0b013e3181a594c4. View

Cavusoglu H, Kaya R, Turkmenoglu O, Aydin Y . Value of early unilateral decompressive craniectomy in patients with severe traumatic brain injury. Ulus Travma Acil Cerrahi Derg. 2010; 16(2):119-24. View

Marshall L, Smith R, Shapiro H . The outcome with aggressive treatment in severe head injuries. Part I: the significance of intracranial pressure monitoring. J Neurosurg. 1979; 50(1):20-5. DOI: 10.3171/jns.1979.50.1.0020. View

Oh C, Park C, Hyun D, Park H, Yoon S . Comparative Study of Outcomes between Shunting after Cranioplasty and in Cranioplasty after Shunting in Large Concave Flaccid Cranial Defect with Hydrocephalus. J Korean Neurosurg Soc. 2008; 44(4):211-6. PMC: 2588309. DOI: 10.3340/jkns.2008.44.4.211. View

Yang X, Wen L, Shen F, Li G, Lou R, Liu W . Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien). 2008; 150(12):1241-7. DOI: 10.1007/s00701-008-0145-9. View

Cooper D, Rosenfeld J, Murray L, Arabi Y, Davies A, DUrso P . Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011; 364(16):1493-502. DOI: 10.1056/NEJMoa1102077. View

. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007; 24 Suppl 1:S1-106. DOI: 10.1089/neu.2007.9999. View

10.

Aarabi B, Hesdorffer D, Ahn E, Aresco C, Scalea T, Eisenberg H . Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006; 104(4):469-79. DOI: 10.3171/jns.2006.104.4.469. View

11.

Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E . A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001; 17(3):154-62. DOI: 10.1007/s003810000410. View

12.

Eberle B, Schnuriger B, Inaba K, Gruen J, Demetriades D, Belzberg H . Decompressive craniectomy: surgical control of traumatic intracranial hypertension may improve outcome. Injury. 2011; 41(9):894-8. DOI: 10.1016/j.injury.2010.02.023. View

13.

Menon D . Cerebral protection in severe brain injury: physiological determinants of outcome and their optimisation. Br Med Bull. 2000; 55(1):226-58. DOI: 10.1258/0007142991902231. View

14.

Piek J . Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care. 2002; 8(2):134-8. DOI: 10.1097/00075198-200204000-00008. View

15.

Akins P, Guppy K . Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management. Neurocrit Care. 2007; 9(2):269-76. DOI: 10.1007/s12028-007-9033-z. View

16.

Cooper D, Rosenfeld J, Murray L, Wolfe R, Ponsford J, Davies A . Early decompressive craniectomy for patients with severe traumatic brain injury and refractory intracranial hypertension--a pilot randomized trial. J Crit Care. 2008; 23(3):387-93. DOI: 10.1016/j.jcrc.2007.05.002. View

17.

Marshall L . Head injury: recent past, present, and future. Neurosurgery. 2000; 47(3):546-61. DOI: 10.1097/00006123-200009000-00002. View

18.

Figaji A, Fieggen A, Peter J . Early decompressive craniotomy in children with severe traumatic brain injury. Childs Nerv Syst. 2003; 19(9):666-73. DOI: 10.1007/s00381-003-0804-3. View

19.

Yoo D, Kim D, Cho K, Huh P, Park C, Kang J . Ventricular pressure monitoring during bilateral decompression with dural expansion. J Neurosurg. 1999; 91(6):953-9. DOI: 10.3171/jns.1999.91.6.0953. View

20.

Guerra W, Gaab M, Dietz H, Mueller J, Piek J, Fritsch M . Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg. 1999; 90(2):187-96. DOI: 10.3171/jns.1999.90.2.0187. View