[Treatment measures in traumatic extracerebral hemorrhage. Management of epi-/subdural hemorrhage and prognosis]

Abstract

Surgical therapy for intracranial extracerebral haemorrhages is one of the oldest surgical techniques. The low mortality and morbidity in recent years have come about through of the emergency service, modern neurosurgical techniques, widespread use of the CT scanner, and adequate intensive care. The treatment target in the case of head injuries is to provide the optimal milieu for recovery from the primary injury and to prevent secondary damage to the brain. Acute subdural haematomas (SDH) are the most frequent traumatic lesion. The outcome is related more to the degree of associated brain damage than to the subdural clot itself. Once the stability of vital functions has been assured to prevent intracranial hypertension, a craniotomy to remove the haematoma must follow immediately. Intracranial pressure (ICP) monitoring is mandatory after evacuation of the clot. Results of the preliminary analysis of the Traumatic Coma Data Bank (TCDB) show a 50% mortality rate after operative treatment of subdural haematomas. Chronic SDH is a different entity in terms of manifestations, time course and outcome. Twist drill evacuation of the fluid (= chronic haematoma) in local anaesthesia is now accepted as the treatment of choice. An extradural haematoma is a potentially lethal lesion with a mortality rate of 5%. Emergency surgical intervention is appropriate before neurological signs appear.