J Korean Neurosurg Soc.  2014 Jun;55(6):348-352. 10.3340/jkns.2014.55.6.348.

Surgery for Bilateral Large Intracranial Traumatic Hematomas: Evacuation in a Single Session

• Kompheak H
• Hwang SC
• Kim DS
• Shin DS
• Kim BT

• KMID: 2191115
• DOI: http://doi.org/10.3340/jkns.2014.55.6.348

Abstract

OBJECTIVE
Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia.
METHODS
In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated.
RESULTS
The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived.
CONCLUSION
Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

Keyword

Intracranial hemorrhages; Epidural hematoma; Craniotomy; Multiple lesions

MeSH Terms

Anesthesia
Craniotomy
Decompressive Craniectomy
Glasgow Coma Scale
Glasgow Outcome Scale
Hematoma*
Humans
Intracranial Hemorrhages

Figure

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  Fig. 1 CT scans of case 5. Preoperative CT images (A and B) show a large epidural hematoma in the left temporo-parietal area and an intracerebral hematoma in the right temporal lobe. The basal cisterns and cortical sulci are obliterated but no midline shift was seen. A linear skull fracture is seen on the left temporal bone (C). The hematomas were removed through a craniectomy in the left temporo-parietal and a burr hole in the right temporal area. The cisterns can be seen in the postoperative CT image (D).

• 

  Fig. 2 CT scans of case 7. Preoperative CT images (A and B) show a large epidural hematoma in the right temporo-parietal area and an intracerebral hematoma on the left frontal lobe. No midline shift or cortical sulci was found. The epidural hematoma was removed through a larger craniotomy and the intracerebral hematoma was evacuated through a smaller craniotomy on the left frontal bone (C and D).

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