Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury
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ORIGINAL ARTICLE
Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury J. L. Flordelı´s Lasierra • C. Garcı´a Fuentes D. Toral Va´zquez • M. Chico Ferna´ndez • S. Bermejo Azna´rez • E. Alted Lo´pez
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Received: 31 October 2012 / Accepted: 12 February 2013 / Published online: 27 February 2013 Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose The development of a contralateral extraaxial hematoma has repeatedly been described in small series and descriptive studies. However, the evidence available to date is limited. Objectives To evaluate the incidence and risk factors leading to the development of a contralateral extraaxial hematoma and to describe the characteristics of cases. Methods A retrospective cohort study with prospective data collection was undertaken. All patients admitted to an intensive care unit (ICU) from 2006 to 2010 were studied. The inclusion criteria were as follows: severe trauma [Injury Severity Score (ISS C 16)], neurosurgery (NeuroSx) in the first 24 h. The following were excluded:
J. L. Flordelı´s Lasierra C. Garcı´a Fuentes D. Toral Va´zquez M. Chico Ferna´ndez S. Bermejo Azna´rez E. Alted Lo´pez Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain e-mail: [email protected] D. Toral Va´zquez e-mail: [email protected] M. Chico Ferna´ndez e-mail: [email protected] S. Bermejo Azna´rez e-mail: [email protected] E. Alted Lo´pez e-mail: [email protected] J. L. Flordelı´s Lasierra (&) Paseo de Las Acacias 30, block 4, floor 8th-A, 28005 Madrid, Spain e-mail: [email protected]
subacute/chronic subdural hematomas, first bilateral NeuroSx. Cases were those who required immediate contralateral NeuroSx after the first NeuroSx due to the occurrence of a new extraaxial injury or significant growth of a previous one. Controls were those patients those who did not require second NeuroSx or who required reoperation due to ipsilateral lesions. The variables considered were: demographics, neurological assessment, traumatic injuries and severity, image and surgical findings, clinical course, and outcome. Statistics analysis comprised descriptive, inferential, and multivariate analysis by logistic regression. Results A total of 120 patients were included, among which there were 11 cases (incidence 9.2 %). The cases showed a significantly higher frequency of coma or severe traumatic brain injury (TBI) at admission, contralateral injury and contralateral skull fracture in the preoperative computed tomography (CT) scan, as well as decompressive craniectomy. There were no significant differences in the severity scores, clinical course, or outcomes. The presence of contralateral fracture was identified as an independent risk factor [relative risk (RR) 47.9, 95 % confidence interval (CI) 5.2–443]. Conclusions Contralateral extraaxial hematoma is a rare entity, although it has a high mortality rate. Therefore, it requires
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