J Neurointensive Care.  2022 Oct;5(2):54-59. 10.32587/jnic.2022.00528.

Postoperative Radiological Factors Associated with Early Mortality after Decompressive Craniectomy in Acute Subdural Hematoma

• Ryu MH
• Suh SJ
• Lee MS
• Lee YS
• Lee JH
• Cho SH

• KMID: 2555068
• DOI: http://doi.org/10.32587/jnic.2022.00528

Abstract

Background
Acute subdural hematoma (SDH) often leads to serious neurological deterioration or death. Patients with acute SDH are recommended decompressive craniectomy (DC) if their brain edema is severe. We investigated the association with early mortality through postoperative radiological studies after surgery.
Methods
We retrospectively reviewed 31 out of 85 patients that underwent DC due to acute SDH at our neurosurgical department in January 2011–December 2020. The effect of decompression was estimated through comparison with preoperative and postoperative midline shift (MS) in brain computed tomography (CT). Brain edema was represented as an increased value, measured by comparing the lateral displaced parenchymal diameter with the normal brain diameter.
Results
Of the total 31 patients, 15 died during hospitalization (group A) and 16 had the same or improved neurological status (group B). The reduction rate of MS was shown as higher in group B than in group A; it was significantly different between the two groups. The difference between the two values (DBD) was calculated by measuring the brain diameter of the operative site after DC and normal brain diameter for the progress of brain edema. The difference value of MS (DMS) was greater than DBD for 33.3% and 81.3% of group A and B patients, respectively.
Conclusion
A lower MS reduction rate or higher DBD than DMS increases a patient’s early mortality rate. Therefore, early mortality in acute SDH patients who underwent DC could be predicted through analysis of postoperative brain CT.

Keyword

Acute subdural hematoma; Brain edema; Decompressive craniectomy; Mortality