Korean J Neurotrauma.  2016 Apr;12(1):22-27. 10.13004/kjnt.2016.12.1.22.

Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome

• Kwon YS
• Yang KH
• Lee YH

• KMID: 2163011
• DOI: http://doi.org/10.13004/kjnt.2016.12.1.22

Abstract

OBJECTIVE
Craniotomy (CO) and decompressive craniectomy (DC) are two main surgical options for acute subdural hematomas (ASDH). However, optimal selection of surgical modality is unclear and decision may vary with surgeon's experience. To clarify this point, we analyzed preoperative findings and surgical outcome of patients with ASDH treated with CO or DC.
METHODS
From January 2010 to December 2014, data for 46 patients with ASDH who underwent CO or DC were retrospectively reviewed. The demographic, clinical, imaging and clinical outcomes were analyzed and statistically compared.
RESULTS
Twenty (43%) patients underwent CO and 26 (57%) patients received DC. In DC group, preoperative Glascow Coma Scale was lower (p=0.034), and more patient had non-reactive pupil (p=0.004). Computed tomography findings of DC group showed more frequent subarachnoid hemorrhage (p=0.003). Six month modified Rankin Scale showed favorable outcome in 60% of CO group and 23% of DC group (p=0.004). DC was done in patient with more unfavorable preoperative features (p=0.017). Patients with few unfavorable preoperative features (<6) had good outcome with CO (p<0.001).
CONCLUSION
In selective cases of few unfavorable clinical findings, CO may also be an effective surgical option for ASDH. Although DC remains to be standard of surgical modality for patients with poor clinical status, CO can be an alternative considering the possible complications of DC.

Keyword

Hematoma, subdural, acute; Craniotomy; Decompressive craniectomy; Treatment outcome

MeSH Terms

Coma
Craniotomy*
Decompressive Craniectomy*
Hematoma, Subdural, Acute*
Humans
Pupil
Retrospective Studies
Subarachnoid Hemorrhage
Treatment Outcome

Figure

• 

  FIGURE 1 Preoperative (A) and postoperative (B) computed tomography (CT) scan of 75-year-old female with acute subdural hematomas (ASDH) after traumatic brain injury. She underwent craniotomy and evacuation of hematoma without remarkable postoperative brain swelling. Another case of 78-year-old male with ASDH (C, D) who underwent decompressive craniectomy. Preoperative (C) and postoperative (D) CT scan shows brain swelling, but removal of bone aids in control of raised intracranial pressure.

• 

  FIGURE 2 Measurement of midline shift (A), and swelling above bone flap margin (B). Imaginary line to absent bone flap was drawn congruent with measurement of contralateral hemisphere and brain tissue above the imaginary line was measured (B).

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