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. 2013 Jan;8(1):15-20.
doi: 10.4103/1793-5482.110275.

Decompressive craniectomy with multi-dural stabs - A combined (SKIMS) technique to evacuate acute subdural hematoma with underlying severe traumatic brain edema

Abdul Rashid Bhat  1 , Altaf Rehman Kirmani, Mohammed Afzal Wani
Affiliations

Decompressive craniectomy with multi-dural stabs - A combined (SKIMS) technique to evacuate acute subdural hematoma with underlying severe traumatic brain edema

Abdul Rashid Bhat et al. Asian J Neurosurg. 2013 Jan.

Abstract

Context: The decompressive craniotomy alone or with dural flap opening to evacuate acute subdural hematoma with underlying brain edema in severe traumatic brain injury has proved either insufficient in the first place or has fatal complications secondly.

Aims: To reduce the fatality of conventional procedures and to evacuate acute subdural hematoma with severe brain edema by a combination of decompressive craniotomy and multi-dural stabs (SKIMS-Technique) without brain pouting and lacerations in low Glasgow coma scale (GCS) score patients.

Settings and design: The prospective study was conducted in the Department of Neurosurgery, from June, 2006 to June 2011, under a uniform protocol.

Materials and methods: A total of 225 patients of severe brain trauma were admitted to the accident and emergency unit of Neurosurgery and after initial resuscitation a CT brain was performed. All patients had a GCS score of 8 and below. All patients were ventilated postoperatively and ICP was monitored.

Statistical analysis used: The data was analyzed and evaluated by the statistical methods like student's T-test. The analysis of Variance was used where-ever applicable.

Results: The survival of multi-dural stab group was 77.31% (92/119) with good recovery in 42.02% (50/119) and a mortality of 22.69% (27/119) as compared with 46.23% (49/106) survival in open dural flap (control) group with 15.09% (16/106) good recovery and mortality of 53.77% (57/106).

Conclusions: This new approach, known as SKIMS-Technique or Combined Technique i.e., "decompressive craniectomy with multi-dural stabs", proved much effective in increasing survival of low GCS and severe traumatic brain edema patients with acute subdural hematoma.

Keywords: Acute subdural hematoma; SKIMS-technique; decompressive craniectomy; multi-dural stabs; outcome; severe brain edema.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Plain CT-scan brain in a closed head injury shows acute subdural hematoma, midline shift, obliteration of cisterns and ventricles due to brain edema
Figure 2
Figure 2
Plain CT-scan at 4 weeks of multi-dural stabs, resolving contusion after severe brain edema, and acute subdural hematoma with replaced bone flap
Figure 3
Figure 3
Bluish, bulging and tense dura, overlying severe brain edema and acute subdural hematoma, after wide craniectomy
Figure 4
Figure 4
Technique of multi-dural stabs parallel to vessels leading to gradual decompression
Figure 5
Figure 5
The multi-stabbed, relaxed, depressed and grayish-blue dura after evacuation of subdural hematoma
See this image and copyright information in PMC

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