Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar-Apr;36(3):412-415.
doi: 10.12669/pjms.36.3.1771.

Role of surgical modality and timing of surgery as clinical outcome predictors following acute subdural hematoma evacuation

Imran Altaf  1 , Shahzad Shams  2 , Anjum Habib Vohra  3
Affiliations

Role of surgical modality and timing of surgery as clinical outcome predictors following acute subdural hematoma evacuation

Imran Altaf et al. Pak J Med Sci. 2020 Mar-Apr.

Abstract

Background & objective: A Craniotomy (CO) or decompressive craniectomy (DC) are the two main surgical procedures employed for evacuation of acute traumatic subdural hematoma (ASDH). However, the optimal surgical procedure remains controversial. The beneficial effect of early surgical evacuation of acute subdural hematoma in improving outcome also remains unclear. Our objective was to study the role of these two parameters in determining the outcome in patients undergoing surgical evacuation of acute traumatic subdural hematoma.

Methods: A retrospective analysis of 58 patients presenting with acute traumatic subdural hematoma and with presenting Glasgow Coma Scale (GCS) ≤ 8 that had been operated in Lahore General Hospital between June 2014 and July 2015 was performed. The demographic data, preoperative GCS, type of surgical procedure performed and timing of surgery were analysed.

Results: Forty (69%) patients underwent CO, and eighteen (31%) patients underwent DC. The CO and DC groups showed no difference in the demographic data and preoperative GCS. Six patients survived in the craniotomy group, while none survived in the decompressive craniectomy group (p=0.083). The relationship of timing of surgery with survival in the craniotomy group was found not to be clinically significant (p=0.87).

Conclusion: In this study craniotomy was associated with a better outcome as compared to decompressive craniectomy, however, the difference did not reach statistical significance. Early surgery was also found not to be associated with an improved outcome.

Keywords: Acute subdural hematoma; Craniotomy; Decompressive craniectomy; Timing of surgery.

PubMed Disclaimer

References

    1. Fountain DM, Kolias AG, Lecky FE, Bouamra O, Lawrence T, Adams H, et al. Survival Trends After Surgery for Acute Subdural Hematoma in Adults Over a 20-year Period. Ann Surg. 2017;265(3):590–596. doi:10.1097/SLA.0000000000001682. - PMC - PubMed
    1. Monsivais D, Huimahn A Choi, Ryan Kitagawa, Franch M, Cai C. A retrospective analysis of surgical outcomes for acute subdural hematoma in an elderly cohort. Interdiscip Neurosurg. 2018;14:130–134. doi:10.1016/j.inat.2018.07.010.
    1. Lavrador JP, Teixeira JC, Oliveira E, Simao D, Santos MM, Simas N. Acute Subdural Hematoma Evacuation:Predictive Factors of Outcome. Asian J Neurosurg. 2018;13(3):565–571. doi:10.4103/ajns.AJNS_51_16. - PMC - PubMed
    1. Lee D, Song SW, Choe WJ, Cho J, Moon CT, Koh YC. Risk Stratification in Patients with Severe Traumatic Acute Subdural Hematoma. Nerve. 2017;3(2):50–57. doi:10.21129/nerve.2017.3.2.50.
    1. Chen SH, Chen Y, Fang WK, Huang DW, Huang KC, Tseng SH. Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma. 2011;71(6):1632–1636. doi:10.1097/TA.0b013e3182367b3c. - PubMed

LinkOut - more resources