Surgical Outcome Following a Decompressive Craniectomy for Acute Epidural Hematoma Patients Presenting with Associated M
Acute epidural hematomas (AEDH) are generally managed with rapid surgical hematoma evacuation and bleeding control. However, the surgical outcome of patients with serious brain edema is poor. This study reviewed the clinical outcome for AEDH patients and
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Abstract Acute epidural hematomas (AEDH) are generally managed with rapid surgical hematoma evacuation and bleeding control. However, the surgical outcome of patients with serious brain edema is poor. This study reviewed the clinical outcome for AEDH patients and evaluated the efficacy of the DC, especially in patients with associated massive brain swelling. Eighty consecutive patients surgically treated with AEDH were retrospectively assessed. The patients were divided into two groups: (a) hematoma evacuation (HE: 46 cases) and (b) HE+ an external decompression (ED: 34 cases). The medical charts, operative findings, radiological findings, and operative notes were reviewed. In the poor outcome group, there were 18 patients (72%), with a GCS score of less than 8 (severe injury), and 22 patients (88%) who showed pupil abnormalities. Many more patients showed a midline shift, basal cistern effacement, and brain contusion in comparison to the favorable outcome group. In the favorable outcome group, almost all of the patients (98%) showed less than 12 mm of a midline shift. The influential factors may be age, GCS, pupil abnormalities, size, midline shift, basal cistern effacement, coincidence of contusion and swelling. We conclude that an A DC may be effective to manage the AEDH patients with cerebral contusion or massive brain swelling. Keywords External decompression • cerebral swelling • surgical outcome • head injury
Introduction Acute epidural hematomas (AEDHs) are generally managed with rapid surgical hematoma evacuation and bleeding control. In particular, an AEDH greater than 10 mm in thickness, 30
N. Otani () Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, Japan e-mail: [email protected]
cm3 in hematoma volume, or a 5 mm midline shift in patients with a GCS score of less than 8 and with focal deficits should immediately undergo surgical correction (4). However, the surgical outcome of patients in critical condition with serious brain edema is poor due to the significant mass effect and brain stem compression. (5,9). On the other hand, a decompressive craniectomy (DC) can reduce the morbidity and mortality in critically ill patients with a severe head injury (1,2,7,12). This study reviewed the clinical outcome in a total of 80 surgically treated AEDH patients and evaluated the efficacy of DC, especially in patients with associated massive cerebral contusion or brain swelling.
Patients and Methods Eighty consecutive patients surgically treated for AEDH between January 1997 and December 2004 were retrospectively assessed. The patients’ hospital records, including their medical charts, intensive care unit flow sheets, operative records, anesthesia records and radiological findings such as head CT scans, were reviewed. The patients were divided into two groups: (a) hematoma evacuation (HE: 46 cases) and (b) HE+ an external decompression (ED: 34 cases). The patient outcome was assessed upon discharge using the Glasgow Outcome Scale (GO
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