Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma
Journal
Journal of Trauma - Injury, Infection and Critical Care
Journal Volume
71
Journal Issue
6
Pages
1632-1636
Date Issued
2011
Author(s)
Abstract
Background: Decompressive craniectomy (DC) is helpful in lowering the intracranial pressure in patients with severe head injuries. However, it is still unclear which surgical approach (DC or craniotomy) is the optimal treatment strategy for severely head-injured patients with acute subdural hematoma (SDH). To clarify this point, we compared the outcomes and complications of the patients with acute SDH and low Glasgow Coma Scale (GCS) score treated with craniotomy or DC. Methods: We analyzed 102 patients with acute SDH and GCS scores of 4 to 8. Of them, 42 patients (41.2%) were treated with craniotomy and 60 (58.8%) treated with DC for evacuation of hematoma. The demographic and clinical data were analyzed including patient age, sex, injury mechanism, GCS score, pupil size and light reflex, time interval from injury to operation, types of surgical procedures, intracranial findings in pre- and postoperative computed tomography scan, intracranial pressure, complications, requirement of permanent cerebrospinal fluid diversion, and Glasgow Outcome Scale score after at least 1 year of follow-up. Results: The craniotomy and DC groups showed no difference in the demographic and clinical data. There was no difference in the outcomes and complication rates between these two groups except that the DC group had higher mortality than the craniotomy group (23.3% vs. 7.1%, p = 0.04). Conclusion: Both craniotomy and DC were feasible treatment strategies for acute SDH. The patients with acute SDH and low GCS score treated with craniotomy or DC showed no difference in the outcomes and complications. Copyright ? 2011 Lippincott Williams & Wilkins.
Subjects
Acute subdural hematoma; Complication; Craniotomy; Decompressive craniectomy; Outcome
SDGs
Other Subjects
mannitol; adult; article; assault; brain hematoma; brain infarction; brain ventricle peritoneum shunt; cerebrospinal fluid diversion; cerebrospinal fluid shunting; clinical feature; computer assisted tomography; controlled study; craniotomy; decompressive craniectomy; demography; epidural hematoma; falling; female; follow up; Glasgow coma scale; head injury; human; hypovolemia; injury severity; intracranial hypertension; intracranial pressure; major clinical study; male; neuroimaging; neurosurgery; outcome assessment; pneumonia; postoperative complication; postoperative period; preoperative period; priority journal; pupil; pupil reflex; resuscitation; seizure; sex difference; subdural effusion; subdural hematoma; surgical mortality; surgical technique; traffic accident; treatment outcome; urinary tract infection; Adult; Aged; Brain Injuries; Cause of Death; Cohort Studies; Craniotomy; Decompressive Craniectomy; Female; Glasgow Coma Scale; Hematoma, Subdural, Acute; Hospital Mortality; Humans; Injury Severity Score; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Risk Assessment; Survival Analysis; Taiwan; Tomography, X-Ray Computed
Type
journal article