Article
Craniectomy and craniotomy after acute SDH - Clinical course and outcome
Kraniotomie und Kraniektomie nach akutem Subduralhämatom – klinischer Verlauf und Ergebnis
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Published: | April 23, 2004 |
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Outline
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Objective
Early decompression could be a potential surgical procedure to improve outcome after acute subduralhaematoma (SDH). The aim of this study was to investigate the influence of early craniectomies and craniotomies on the outcome after SDH.
Methods
We retrospectively evaluated the charts of 180 patients (63% men, 55.2 years mean) who had been treated in our department in the last ten years. We registrated clinical, radiological, surgical data and the postoperative course. 87% had a follow-up after 5.1 years,mean, according to the Glasgow outcome scale.
Results
63% of the patients suffered from severe head injury. A mydriasis was found in 28%, 15% had dilated pupils on both sides. Age and mydriasis significantly correlated to worse outcome (p<0.0001). The SDH was treated with a craniotomy in 61.6%, the remaining had a craniectomy. The GCS did not differ between both groups, but patients with a mydriasis were significantly more often in the craniectomy group (54%, p<0.05). Patients with a craniotomy had a remaining SDH, significantly more often, compared to patients with craniectomy (63% versus 40%, p<0.05), but the remaining complication rate was not different. 45% of patients with unilateral mydriasis in the craniectomy group reached favourable outcome compared to 38% in the craniotomy group. Comparing both groups with different surgical procedures, signs of herniation had a significant influence on outcome, despite early decompression (p<0.0005).
Conclusions
There seems to be no advantage for early decompression after SDH. Age and signs of herniation were the most predictive factors despite different surgical procedures.