Korean J Neurotrauma.  2016 Apr;12(1):11-17. 10.13004/kjnt.2016.12.1.11.

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

• Oh CH
• Shim YS
• Yoon SH
• Hyun D
• Park H
• Kim E

• KMID: 2163009
• DOI: http://doi.org/10.13004/kjnt.2016.12.1.11

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.

Keyword

Acute subdural hematoma; Early operation; Decompression; Survival rate; Neurological improvement

MeSH Terms

Brain
Brain Stem
Decompression*
Decompressive Craniectomy
Glasgow Coma Scale
Hematoma, Subdural, Acute*
Humans
Retrospective Studies*
Survival Rate

Figure

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  FIGURE 1 Flow chart of patient inclusion for those who underwent decompressive craniectomy from 2002 to 2012.

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  FIGURE 2 Diagram of brain compression ratio with acute subdural hematoma (ASDH). a: the distance between the most medial side of the caudate nucleus head and an imaginary midline from the anterior to posterior falx at the level of the frontal horn of the lateral ventricle, b: the distance between the most lateral side of ASDH and the inner skull table at the same level where parameter a is measured.

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