Surgical management of traumatic interhemispheric subdural hematoma.

Abstract

To review our experience in the surgical treatment of TISH, and to analyze prognostic factors. Clinical and imaging data, surgical modalities, and outcomes of 21 patients with TISH who were treated with microsurgery were analyzed retrospectively. Prognostic factors for outcome were analyzed by univariate analysis. Long-term follow up with outcome assessment according to the Glasgow Outcome Scale (GOS) showed good recovery in 16 cases, moderate disability in two cases, severe disability in one case, and death in two cases. During surgery the origin of bleeding could be identified in all 21 cases. A rupture of the distal anterior cerebral artery or veins in the interhemispheric fissure was seen more frequently in patients with whole interhemispheric fissure hematoma, while hemorrhage from brain tissue laceration was seen more frequently in patients with more localized hematomas. The outcome in patients with an identified rupture of a vessel was better than in those with cortical laceration. Preoperative GCS score and thickness of the interhemispheric hematoma were correlated with outcome (P=0.001 and P=0.004, respectively). Outcome after surgical treatment for TISH can be good, and careful surgical planning and microsurgical techniques to preserve venous drainage are essential.