Korean J Neurotrauma.  2017 Oct;13(2):108-112. 10.13004/kjnt.2017.13.2.108.

Clinical Features and Outcomes of Bilateral Decompression Surgery for Immediate Contralateral Hematoma after Craniectomy Following Acute Subdural Hematoma

Affiliations
  • 1Department of Neurosurgery, Gachon University, Gil Medical Center, Incheon, Korea. samddal@gilhospital.com

Abstract


OBJECTIVE
Immediate contralateral epidural hematoma (EDH) and traumatic intracerebral hematoma (T-ICH) after craniectomy for traumatic subdural hematoma (SDH) are rare but devastating post-operative complications. Their clinical features and outcomes are not well studied. In this report, we present the clinical features and outcomes of immediate contralateral acute hematoma cases requiring a second operation.
METHODS
This study includes 10 cases of immediate contralateral EDH and T-ICH following bilateral craniectomy for the evacuation of traumatic SDH and contralateral hematoma between 2004 and 2015. Their medical records and radiographic findings were reviewed and analyzed retrospectively.
RESULTS
Ten of the 528 patients (1.89%) who underwent craniectomy for the evacuation of traumatic SDH developed post-operative EDH (n=5), T-ICH (n=5). The trauma was caused by a fall in 5 patients and by a traffic accident in 5 patients. The patients who suffered trauma due to pedestrian accidents died. Seven patients had a low admission Glasgow Coma Scale (GCS; GCS≤8) score in the preoperative state (average admission GCS, 7.7; average discharge GCS, 3.4; and average discharge Glasgow Outcome Scale, 2.0). Severe intra-operative brain swelling was noted in all patients, while skull fracture was observed in 8. Multiple associated injuries and medication for heart disease were characteristic of patients who died.
CONCLUSION
The prognosis of delayed contralateral hematoma was very poor. Multiple associated injuries, past medical history and traffic accidents, especially pedestrians were seemed to be associated with higher mortality rates. Finally, contralateral skull fractures can indicate high risk of delayed contralateral acute intracranial hematoma.

Keyword

Decompressive craniectomy; Hematoma, subdural, acute; Skull fractures

MeSH Terms

Accidents, Traffic
Brain Edema
Decompression*
Decompressive Craniectomy
Glasgow Coma Scale
Glasgow Outcome Scale
Heart Diseases
Hematoma*
Hematoma, Subdural
Hematoma, Subdural, Acute*
Humans
Medical Records
Mortality
Pedestrians
Prognosis
Retrospective Studies
Skull Fractures
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