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

• Choi YH
• Lim TK
• Lee SG

• KMID: 2394543
• DOI: http://doi.org/10.13004/kjnt.2017.13.2.108

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

Figure

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  FIGURE 1 A 58-year-old woman requiring bilateral craniectomy caused by delayed epidural hematoma (EDH) after craniectomy for acute subdural hematoma (SDH). (A) Pre-operative computed tomography (CT) scan show traumatic SDH and subarachnoid hemoorhage on the left frontotemporoparietal region. (B) Pre-operative CT (bone setting) show skull fracture on right temporoparietal bone. (C) Post first operative CT show left craniectomy state and contralateral EDH. (D) CT taken after bilateral craniectomy.

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