Surgical Management of Acute Epidural Hematomas (original) (raw)
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Acute Subdural Hematomas; management, complications and outcome -a tertiary center experience AUTHOR
Background: acute subdural hematoma is the most common traumatic intracranial hematoma which carries highest mortality. It's a type of hemorrhage that occurs beneath the dura and is usually associated with other brain injuries. These a number of variables include like age, mechanism of injury, neurological condition on admission, postoperative intracranial pressure (ICP), and time of injury to surgical evacuation contribute to mortality and morbidity in acute SDH. In the present study the management, complications and outcome of acute SDH will be studied. Methods: The study was prospective in nature conducted on all patients of acute subdural hematoma admitted in the Department of neurosurgery, Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Srinagar for a period of two years between June 2015-August 2017. 150 patients diagnosed with acute subdural hematoma were recruited into the study. Results: In this study acute subdural hematoma was most common in the age group of 21-30 year which was 22% followed by age group of 31-40 years which was about 21.3% with male predominance in all age groups. Most common mode of head injury was road traffic accidents which was found in 67 patients (44.7%) followed by fall from height which was found in 59 patients (39.3%). Most common symptom in acute SDH was Loss of consciousness in 50(33.3 %) patients followed by Vomiting in 43 (28.66%). Glasgow coma scale (GCS) <8 at presentation was found in 73(48.66%) patients followed by GCS of 9-12 in 39(26%) patients. Unilateral dilated pupil which was found in majority of patients. Most patients had thicker SDH>10 mm (50.66%) with significant midline shift and associated contusion (35.33%). Most common location of acute subdural hematoma was in fronto-temporo-parietal region which was found in 44.7% of patients followed by temporal region which was found in 30.7% of patients. Only a minority of patients (20%) were managed conservatively. Most common postoperative complication during hospital stay in our study was chest infection in 30% of patients followed by sepsis in 19.33% of patients. With age there is increase in mortality. Mortality is highest in age group of 60-65 which is 86.20% and lowest in 1-20 age group which is 26.08%. Mortality of Acute subdural hematoma with associated SAH is 55.55% followed by patients associated with Contusion which is 49.05%. Mortality of Acute subdural hematoma with associated SAH is 55.55% followed by patients associated with Contusion which is 49.05%. Mortality rate increased with delay in surgery with delay of >12 hours the mortality is 58.82%. Most of the patients presented with GCS< 8 at the time of presentation to hospital and had a mortality of 78.08%, which indicates very bad prognosis. Conclusion: Traumatic acute SDH is a fatal condition despite all developments in neurosurgical interventions. GCS score, hematoma size, midline shift and associated brain injury are important parameters influencing mortality and morbidity. Early intubation, hyperventilation, prevention and treatment of shock, and surgical decompression and management of increased intracranial pressure are basic requisites for meaningful recovery in patients with severe head injury and acute subdural hematoma.
Epidural Hematoma Complication after Rapid Chronic Subdural Hematoma Evacuation: A Case Report
American Journal of Case Reports, 2015
Objective: Diagnostic/therapeutic accidents Background: Chronic subdural hematoma generally occurs in the elderly. After chronic subdural hematoma evacuation surgery, the development of epidural hematoma is a very rare entity. Case Report: We report the case of a 41-year-old man with an epidural hematoma complication after chronic subdural hematoma evacuation. Under general anesthesia, the patient underwent a large craniotomy with closed system drainage performed to treat the chronic subdural hematoma. After chronic subdural hematoma evacuation, there was epidural leakage on the following day. Conclusions: Although trauma is the most common risk factor in young CSDH patients, some other predisposing factors may exist. Intracranial hypotension can cause EDH. Craniotomy and drainage surgery can usually resolve the problem. Because of rapid dynamic intracranial changes, epidural leakages can occur. A large craniotomy flap and silicone drainage in the operation area are key safety points for neurosurgeons and hydration is essential.
Pakistan Journal Of Neurological Surgery
Objective: We designed the present study to compare the clinical outcomes of the craniotomy and the decompressive craniectomy procedures that we had performed in our department for evacuating traumatic acute subdural hematomas. Material and Methods: We retrospectively analyzed the medical data of all the adult patients in whom a craniotomy or a decompressive craniectomy had been performed for evacuating acute traumatic subdural hematoma. The demographic data, the preoperative Glasgow Coma Scale (GCS), and the clinical outcome were studied. Results: A craniotomy had been carried out in five patients for traumatic AcSDH evacuation while in twelve patients a decompressive craniectomy had been performed. The mean preoperative GCS was 9 in the patients that underwent a craniotomy, whereas the mean preoperative GCS in the decompressive craniectomy group was 6.8. The overall mortality was 47%. In the craniotomy group, 4 (80%) patients survived and 1 (20%) patient expired. In the decomp...
Neurochirurgie, 2008
Bleeding after surgery for chronic subdural hematoma far from the operative site is a rare phenomenon with possibly serious consequences. We report a case of combined epidural and intracerebral hemorrhage immediately after evacuation of bilateral chronic subdural hematoma. The epidural hematoma was evacuated by emergency craniotomy, but the deep parenchymal hematoma was treated conservatively. The patient recovered progressively with a good outcome. Approximately 30 cases of chronic subdural hematomas complicated by intracerebral hematoma were previously reported, but only seven cases of epidural hematoma. These complications could be avoided if slow, gradual decompression is used during surgery. Clinicians should suspect its occurrence without delay when a postoperative neurological deterioration is demonstrated. Possible mechanisms are discussed.
Bratislava Medical Journal, 2021
INTRODUCTION: Bilateral fi nding of non-acute subdural hematomas (NASH) is less common compared to unilateral occurrence. The aim of this study was to evaluate results of surgical treatment of bilaterally treated bilateral NASH. METHODS: Retrospective analysis of patients, who underwent bilateral surgical evacuation of NASH (2014-2020). This study was conducted to determine the association between the incidence of postoperative complications and outcome, hematoma recurrence and selected risk factors (including volumetric parameters). Correlations between variables were assessed by using Spearmanˊs correlation. Chi-squared test, Studentˊs t-test (unpaired and paired) and one-way ANOVA were used for univariate analysis. RESULTS: Our study included 29 patients with bilateral NASH who underwent bilateral surgical hematoma evacuation. The laminar hematoma type was associated with higher hematoma recurrence rate (p = 0.032) and worse clinical outcome (p = 0.043). Larger PHV was signifi cantly associated with larger PV after surgery and worse neurological outcome. Larger PHV, PHCV and PV were signifi cantly associated with higher incidence of NASH recurrence (p = 0.0008, p = 0.0007 and p = 0.00006). CONCLUSION: The laminar hematoma type and larger PHV were signifi cant risk factors for the recurrence of bilateral NASH and worse neurological outcome. Larger PHCV and PV were signifi cantly associated with hematoma recurrence (Tab.
Pakistan Journal of Medical Sciences
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 grou...
Annals of Emergency Medicine, 1988
Mortality due to epidural hematoma is virtually restricted to patients who undergo surgery for that condition while in coma. The authors have analyzed the factors influencing the outcome of 64 patients who underwent epidural hematoma evacuation while in coma. These patients represented 41% of the 156 patients operated on for epidural hematoma at their centers after the introduction of computerized tomography (CT). Eighteen patients (28.1%) died, two (3.1%) became severely disabled, and 44 (68.8%) made a functional recovery. The mortality rate for the entire series was 12%, significantly lower than the 30% rate observed when only angiographic studies were available. A significant correlation was found between the final result and the mechanism of injury, the interval between trauma and surgery, the motor score at operation, the hematoma CT density (homogeneous vs. heterogeneous), and the hematoma volume. The patient's age, the course of consciousness before operation (whether there was a lucid interval), and the clot location did not correlate with the final outcome. The mortality rate was significantly higher in patients operated on within 6 hours or between 6 and 12 hours after injury than in those undergoing surgery 12 to 48 hours after injury. Compared with the patients operated on later, the patients undergoing surgery in the early period were, on the average, older and had more rapidly developing symptoms, more pupillary changes, lower motor scores at surgery, larger hematomas, a higher incidence of mixed CT density clots, more severe associated intracranial lesions, and higher postoperative intracranial pressure (ICP). The mechanism of trauma seems to influence the course of consciousness before and after surgery. Passengers injured in traffic accidents had a lower incidence of a lucid interval and longer postoperative coma than patients with low-speed trauma, suggesting more frequent association of diffuse white matter-shearing injury. The duration of postoperative coma correlated with the morbidity rate in survivors. Forty-eight patients (75%) had one or more associated intracranial lesions, and 70% of these required treatment for elevation of ICP after hematoma evacuation. An ICP of over 35 mm Hg strongly correlated with poor outcome; administration of high-dose barbiturates was the only effective means for lowering ICP in nine of 15 patients who developed severe intracranial hypertension after surgery. This study attempts to identify patients at greater risk for presenting postoperative complications and to define a strategy for control CT scanning and ICP monitoring. KEY WORDS 9 head injury 9 epidural hematoma 9 computerized tomography 9 intracranial pressure
Open Journal of Modern Neurosurgery, 2018
Background: Acute subdural hematoma (ASDH) is considered the most common traumatic brain mass lesion. Its prognosis is still grave despite the improvements in treatment modalities. Its mortality rate was reported to be around 60% until the 1990s. In the last decade, ASDH mortality rate was reduced to the level of 20%-40%. Standard treatment to decrease intracranial tension via hematoma evacuation is associated with decompressive craniotomy and followed by ICU management. Objective: To evaluate the outcome and prognostic factors in patients of acute subdural hematoma treated by surgical evacuation and decompressive craniotomy. Also, outcome of cranioplasty by repositioning of patients own bone or by synthetic mesh methods is evaluated. Patients and Methods: It is one year retrospective study. It was conducted on 53 patients, in trauma unit, Assiut university hospitals. We report time lag between trauma and performed surgery, initial Glasgow coma scale (GCS), age, sex and presence of other intracranial pathologies. Outcome assessment is based on Glasgow outcome scale (GOS) and follow-up extended for 6 months. We include those patients with only (isolated) head trauma, shift of midline more than 5 mm in CT brain. We excluded patients with GCS 3 and fixed dilated pupils as well as patients with GCS higher than 12. We did decompressive craniotomy and duraplasty in all patients. Bone flap of decompressive craniotomy is situated in the abdomen. All functionally recovered patients were submitted for cranioplasty with either replacing patient own bone or by Titanium mesh. Results: We had 39 males and 14 females. Age ranged between 7 and 65 years old. 23 deaths, 10 persistent vegetative state, 10 severe disability, 8 moderate disability and 2 good recovery. The outcome analysis was based on 6 month follow-up. Conclusion: Acute subdural hematoma is a very serious condition. Mortality and morbidity is inti-How to cite this paper: Elshanawany,
Conservative management of significant epidural haematomas
2018
Background: Extradural haematomas form 0.5% of all head injuries (Narayan and Kempisy, Principles of Neurosurgery, 2005). With the extensive blood supply to the vein, injury to the meningeal arteries leads to rapid intracranial bleeding of significant amounts of blood. These patients have traditionally been treated with urgent surgical evacuation of the haematoma to relieve the compression of the brain and brain stem (Bricolo and Pasaut, Neurosurgery 14:8-12, 1984). With the routine use of computed tomography (CT) for management of head injury patients, non-operative management is being used more often in selected patients (Narayan and Kempisy, Principles of Neurosurgery, 2005; Bricolo and Pasaut, Neurosurgery 14:8-12, 1984; Dubey et al., Neurol India 52:443-445, 2004; Offner et al., Am J Surg 192:801-805, 2006). If this can be shown as a suitable alternative to surgical intervention, it will offer a mode of treatment that has fewer potential complications and risks than the traditional surgical route.