Korean J Neurotrauma.  2018 Oct;14(2):76-79. 10.13004/kjnt.2018.14.2.76.

Expanding Subdural Hematomas in the Subacute Stage and Treatment via Catheter Drainage

• Ha JH
• Park JH
• Jeong JH
• Im SB
• Hwang SC

• KMID: 2424316
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.76

Abstract

OBJECTIVE
Rapid expansion of subacute subdural hematomas (saSDHs) is an uncommon complication in the course of acute subdural hematomas (SDHs). The current study evaluated relevant factors and treatment methods for saSDHs with neurologic deterioration and mass effect.
METHODS
A saSDHs was chronologically defined as an SDH occurring 4 to 21 days after head trauma. All cases of surgically treated SDHs were retrieved from the head trauma bank at our institution. Twenty-three patients with expanding saSDHs who met the following criteria were enrolled in the study: defined age of the hematoma, clinical deterioration, and radiological expansion of the hematoma. Cases were analyzed according to demographic factors, trauma mechanism, medical co-morbidity, and surgical method.
RESULTS
Expanding saSDHs occurred more often in older (≥60 years old) than in younger patients (69.6% vs. 30.4%, respectively); they also occurred more often in men than in women (64% vs. 36%, respectively). Antiplatelet or anticoagulant therapy was used in 52% of patients. The Glasgow Coma Scale score was 13 at the time of the trauma and deteriorated to 11 at the time of surgery. The mean time from the trauma to development of the expanding saSDH from an SDH was 13.3 days. Regarding surgical methods, closed-system drainage was performed in 22 patients, and only one patient underwent craniotomy with hematoma removal. All patients exhibited neurological improvements after surgery.
CONCLUSION
An expanding saSDH usually occurs around 13 days after trauma in older adults. Minimal trephination with closed-system drainage can be used to manage an expanding saSDHs.

Keyword

Catheter drainage; Subacute; Subdural hematoma; Trephination

MeSH Terms

Adult
Catheters*
Craniocerebral Trauma
Craniotomy
Demography
Drainage*
Female
Glasgow Coma Scale
Hematoma
Hematoma, Subdural*
Hematoma, Subdural, Acute
Humans
Male
Methods
Trephining

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