gms | German Medical Science

Objective: Acute subdural hematoma (aSDH) is a severe disease. Especially in patients with additional signs of cerebral herniation, surgical treatment is still controversially discussed. However, previously investigated patient populations tend to be heterogeneous. We therefore performed a retrospective analysis of our institutional data in order to analyze factors determining the clinical outcome in these critically ill patients.

Method: Between 2010 and 2014, 196 patients with aSDH underwent surgical treatment in our department. Information including patient characteristics, treatment modality, radiological features, and functional outcome were analyzed. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and was dichotomized into favourable (mRS 0-2) and unfavourable (mRS 3-6) outcome. Furthermore, a multivariate analysis was performed in order to identify independent predictors of functional outcome.

Results: Overall, 26% of patients with aSDH achieved favourable outcome. In a further analysis, the presence of unilateral or bilateral dilated pupils as a sign of cerebral herniation occurred in 47% of the included patients. In the multivariate analysis, the presence of signs of cerebral herniation and age >65 years were significant prognostic predictors for an unfavourable outcome in patients suffering from aSDH. However, 15% of patients with aSDH and signs of cerebral herniation achieved favourable outcome during follow-up.

Conclusions: We provide detailed data on patients suffering from aSDH and signs of cerebral herniation. Despite mydriasis, favourable outcome may be achieved in a significant number of patients. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time.