Korean J Neurotrauma.  2013 Oct;9(2):114-119. 10.13004/kjnt.2013.9.2.114.

Risk Factors for Reoperation after Traumatic Intracranial Hemorrhage

• Yang SM
• Park SQ
• Cho SJ
• Chang JC
• Park HK
• Kim RS

• KMID: 2156111
• DOI: http://doi.org/10.13004/kjnt.2013.9.2.114

Abstract

OBJECTIVE
Progression after operation in traumatic brain injury (TBI) is often correlated with morbidity and poor outcome. We have investigated to characterize the natural course of traumatic intracranial hemorrhage and to identify the risk factors for postoperative progression in TBI.
METHODS
36 patients requiring reoperation due to hemorrhagic progression following surgery for traumatic intracranial hemorrhage were identified in a retrospective review of 335 patients treated at our hospital between 2001 and 2010. We reviewed the age, sex, Glasgow Coma Scale, the amount of hemorrhage, the type of hemorrhage, rebleeding site, coagulation profiles, and so on. Univariate statistics were used to examine the relationship between the risk factors and reoperation.
RESULTS
Acute subdural hematoma was the most common initial lesion requiring reoperation. Most patients had a reoperation within 24-48 hours after operation. Peri-lesional edema (p=0.002), and initial volume of hematoma (p=0.013) were the possible factors of hemorrhagic progression requiring reoperation. But preoperative coagulopathy was not risk factor of hemorrhagic progression requiring reoperation.
CONCLUSION
Peri-lesional edema and initial volume of hematoma were the statistical significant factors requiring reoperation. Close observation with prompt management is needed to improve the outcome even in patient without coagulopathy.

Keyword

Traumatic brain injury; Rebleeding; Progression; Risk factor; Reoperation

MeSH Terms

Brain Injuries
Edema
Glasgow Coma Scale
Hematoma
Hematoma, Subdural, Acute
Hemorrhage
Humans
Intracranial Hemorrhage, Traumatic*
Reoperation*
Retrospective Studies
Risk Factors*

Reference

References

1. Carhuapoma JR, Barker PB, Hanley DF, Wang P, Beauchamp NJ. Human brain hemorrhage: quantification of perihematoma edema by use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 23:1322–1326. 2002.

2. Chang EF, Meeker M, Holland MC. Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period. Neurosurgery. 58:647–656. ; discussion 647–656,. 2006.

3. Chen H, Guo Y, Chen SW, Wang G, Cao HL, Chen J, et al. Progressive epidural hematoma in patients with head trauma: incidence, outcome, and risk factors. Emerg Med Int. 2012:134905. 2012.

4. Chieregato A, Fainardi E, Morselli-Labate AM, Antonelli V, Com-pagnone C, Targa L, et al. Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery. 56:671–680. ; discussion 671–680,. 2005.

5. Cohen MJ, Brohi K, Ganter MT, Manley GT, Mackersie RC, Pittet JF. Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway. J Trauma. 63:1254–1261. ;discussion 1261–1262,. 2007.

6. Engström M, Romner B, Schalén W, Reinstrup P. Thrombocytopenia predicts progressive hemorrhage after head trauma. J Neurotrauma. 22:291–296. 2005.

7. Gebel JM, Sila CA, Sloan MA, Granger CB, Weisenberger JP, Green CL, et al. Comparison of the ABC/2 estimation technique to computer-assisted volumetric analysis of intraparenchymal and subdural hematomas complicating the GUSTO-1 trial. Stroke. 29:1799–1801. 1998.

8. Kurland D, Hong C, Aarabi B, Gerzanich V, Simard JM. Hemorrhagic progression of a contusion after traumatic brain injury: a review. J Neurotrauma. 29:19–31. 2012.

9. Lee KR, Betz AL, Kim S, Keep RF, Hoff JT. The role of the coagulation cascade in brain edema formation after intracerebral hemorrhage. Acta Neurochir (Wien). 138:396–400. ; discussion 400–401,. 1996.

10. Lee KR, Colon GP, Betz AL, Keep RF, Kim S, Hoff JT. Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg. 84:91–96. 1996.

11. Lee KR, Kawai N, Kim S, Sagher O, Hoff JT. Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat model. J Neurosurg. 86:272–278. 1997.

12. Narayan RK, Maas AI, Servadei F, Skolnick BE, Tillinger MN, Marshall LF, et al. Progression of traumatic intracerebral hemorrhage: a prospective observational study. J Neurotrauma. 25:629–639. 2008.

13. Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 96:109–116. 2002.

14. Rockswold GL, Leonard PR, Nagib MG. Analysis of management in thirty-three closed head injury patients who “talked and deteriorated”. Neurosurgery. 21:51–55. 1987.

15. Sansing LH, Kaznatcheeva EA, Perkins CJ, Komaroff E, Gutman FB, Newman GC. Edema after intracerebral hemorrhage: correlations with coagulation parameters and treatment. J Neurosurg. 98:985–992. 2003.

16. Seong HS, Rim BC, Min KS, Lee MS, Kim YG, Kim DH. Progression of intracranial hemorrhage after acute head injury. J Korean Neurotraumatol Soc. 5:62–67. 2009.

17. Stein SC, Young GS, Talucci RC, Greenbaum BH, Ross SE. Delayed brain injury after head trauma: significance of coagulopathy. Neurosurgery. 30:160–165. 1992.

18. White CL, Griffith S, Caron JL. Early progression of traumatic cerebral contusions: characterization and risk factors. J Trauma. 67:508–514. ; discussion 514–515,. 2009.

19. Yang GY, Betz AL, Chenevert TL, Brunberg JA, Hoff JT. Experimental intracerebral hemorrhage: relationship between brain edema, blood flow, and blood-brain barrier permeability in rats. J Neurosurg. 81:93–102. 1994.