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.

Highlights

  • Acute subdural hematoma is considered to be the most lethal traumatic brain injury.[1]

  • A craniotomy and decompressive craniectomy are the two main surgical options employed for evacuation of acute traumatic subdural hematoma, but studies comparing their outcome have shown inconsistent results.[3,5,6]

  • The optimal surgical procedure in patients presenting with traumatic acute subdural hematoma still to date remains controversial.[6,7,8]

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Summary

Introduction

Acute subdural hematoma is considered to be the most lethal traumatic brain injury.[1]. A craniotomy and decompressive craniectomy are the two main surgical options employed for evacuation of acute traumatic subdural hematoma, but studies comparing their outcome have shown inconsistent results.[3,5,6] The optimal surgical procedure in patients presenting with traumatic acute subdural hematoma still to date remains controversial.[6,7,8] The role of timing of surgery as a predictor of outcome remains. Pak J Med Sci March - April 2020 Vol 36 No 3 www.pjms.org.pk 412 unclear, and whether early surgery improves outcome still remains controversial.[1,9] The present study was designed to assess the role of these two parameters as predictors of clinical outcome in patients presenting with acute traumatic subdural hematoma. Surgery was found not to be associated with an improved outcome

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