Reoperations After Surgery for Acute Subdural Hematoma: Reasons, Risk Factors, and Effects

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2019 Jan 24

PMID 30671588

Citations 3

Authors

Jan Chrastina

Cenek Silar

Tomas Zeman

Michal Svoboda

Jan Krajsa

Barbora Musilova

Zdenek Novak

Affiliations

Soon will be listed here.

Abstract

Purpose: To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome.

Methods: Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery-trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied.

Results: Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients.

Conclusions: Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.

Citing Articles

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Outcomes of traumatic brain injury patients with acute epidural and subdural hematoma who underwent burr hole surgery: A two-year study at Kilimanjaro Christian Medical Centre, Tanzania.

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

Bae I, Kim J, Cheong J, Ryu J, Choi K, Han M PLoS One. 2020; 15(4):e0232631.

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References

Kim H, Suh S, Kang H, Lee M, Lee Y, Lee J . Predictable Values of Decompressive Craniectomy in Patients with Acute Subdural Hematoma: Comparison between Decompressive Craniectomy after Craniotomy Group and Craniotomy Only Group. Korean J Neurotrauma. 2018; 14(1):14-19. PMC: 5949517. DOI: 10.13004/kjnt.2018.14.1.14. View

Chen S, Chen Y, Fang W, Huang D, Huang K, Tseng S . Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma. 2011; 71(6):1632-6. DOI: 10.1097/TA.0b013e3182367b3c. View

Kwinta B, Krzyzewski R, Klis K, Donicz P, Gackowska M, Polak J . Emergency Reoperations in Cranial Neurosurgery. World Neurosurg. 2017; 105:749-754. DOI: 10.1016/j.wneu.2017.06.090. View

Shen J, Fan Z, Ji T, Pan J, Zhou Y, Zhan R . Contralateral acute subdural hematoma following traumatic acute subdural hematoma evacuation. Neurol Med Chir (Tokyo). 2013; 53(4):221-4. DOI: 10.2176/nmc.53.221. View

Di Rienzo A, Iacoangeli M, Alvaro L, Colasanti R, di Somma L, Nocchi N . Mini-Craniotomy under Local Anesthesia to Treat Acute Subdural Hematoma in Deteriorating Elderly Patients. J Neurol Surg A Cent Eur Neurosurg. 2017; 78(6):535-540. DOI: 10.1055/s-0037-1599054. View

Endo H, Fukawa O, Mashiyama S, Kawase M . [Single burr hole surgery for acute spontaneous subdural hematoma in the aged: patient reports of three cases]. No Shinkei Geka. 2004; 32(3):271-6. View

Lenzi J, Caporlingua F, Caporlingua A, Anichini G, Nardone A, Passacantilli E . Relevancy of positive trends in mortality and functional recovery after surgical treatment of acute subdural hematomas. Our 10-year experience. Br J Neurosurg. 2016; 31(1):78-83. DOI: 10.1080/02688697.2016.1226253. View

Panczykowski D, Okonkwo D . Premorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas. J Neurosurg. 2010; 114(1):47-52. DOI: 10.3171/2010.7.JNS10446. View

Tsermoulas G, Shah O, Wijesinghe H, Silva A, Ramalingam S, Belli A . Surgery for Acute Subdural Hematoma: Replace or Remove the Bone Flap?. World Neurosurg. 2015; 88:569-575. DOI: 10.1016/j.wneu.2015.10.045. View

10.

Tomycz N, Germanwala A, Walter K . Contralateral acute subdural hematoma after surgical evacuation of acute subdural hematoma. J Trauma. 2008; 68(1):E11-2. DOI: 10.1097/TA.0b013e31811eaaf5. View

11.

Lu T, Guan J, An C . Preoperative trepanation and drainage for acute subdural hematoma: Two case reports. Exp Ther Med. 2015; 10(1):225-230. PMC: 4487041. DOI: 10.3892/etm.2015.2456. View

12.

Desai V, Grossman R, Sparrow H . Incidence of Intracranial Hemorrhage After a Cranial Operation. Cureus. 2016; 8(5):e616. PMC: 4917372. DOI: 10.7759/cureus.616. View

13.

Servadei F, Nasi M, Giuliani G, Cremonini A, Cenni P, Zappi D . CT prognostic factors in acute subdural haematomas: the value of the 'worst' CT scan. Br J Neurosurg. 2000; 14(2):110-6. DOI: 10.1080/02688690050004525. View

14.

Fabbri A, Servadei F, Marchesini G, Stein S, Vandelli A . Predicting intracranial lesions by antiplatelet agents in subjects with mild head injury. J Neurol Neurosurg Psychiatry. 2010; 81(11):1275-9. DOI: 10.1136/jnnp.2009.197467. View

15.

Chrastina J, Hrabovsky D, Zvarova M, riha I, Novak Z . [The effect of anticoagulation and anti-aggregation treatment on the extent, development and prognosis of acute craniocerebral injury]. Acta Chir Orthop Traumatol Cech. 2014; 81(1):77-84. View

16.

Kwon H, Choi K, Yi H, Chun H, Lee Y, Kim D . Risk Factors of Delayed Surgical Intervention after Conservatively Treated Acute Traumatic Subdural Hematoma. J Korean Neurosurg Soc. 2017; 60(6):723-729. PMC: 5678053. DOI: 10.3340/jkns.2017.0506.011. View

17.

Liu X, Qiu Y, Zhang J, Zhang Q, Chen L, Chen L . Emergent Single Burr Hole Evacuation for Traumatic Acute Subdural Hematoma with Cerebral Herniation: A Retrospective Cohort Comparison Analysis. World Neurosurg. 2018; 120:e1024-e1030. DOI: 10.1016/j.wneu.2018.08.219. View

18.

Moussa W, Khedr W, Elwany A . Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study. Neurosurg Rev. 2017; 41(2):483-488. DOI: 10.1007/s10143-017-0873-5. View

19.

Flordelis Lasierra J, Garcia Fuentes C, Toral Vazquez D, Chico Fernandez M, Bermejo Aznarez S, Alted Lopez E . Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury. Eur J Trauma Emerg Surg. 2016; 39(3):277-83. DOI: 10.1007/s00068-013-0268-4. View

20.

Oertel M, Kelly D, McArthur D, Boscardin W, Glenn T, Lee J . Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002; 96(1):109-16. DOI: 10.3171/jns.2002.96.1.0109. View