Acute Subdural Hematoma Patients Research Articles

Correlating Age and Hematoma Volume with Extent of Midline Shift in Acute Subdural Hematoma Patients: Validation of an Artificial Intelligence Tool for Volumetric Analysis

Decision for intervention in acute subdural hematoma patients is based on a combination of clinical and radiographic factors. Age has been suggested as a factor to be strongly considered when interpreting midline shift (MLS) and hematoma volume data for assessing critical clinical severity during operative intervention decisions for acute subdural hematoma patients. The objective of this study was to demonstrate the use of an automated volumetric analysis tool to measure hematoma volume and MLS and quantify their relationship with age. A total of 1789 acute subdural hematoma patients were analyzed using qER-Quant software (Qure.ai, Mumbai, India) for MLS and hematoma volume measurements. Univariable and multivariable regressions analyzed association between MLS, hematoma volume, age, and MLS:hematoma volume ratio. In comparison to young patients (≤ 70 years), old patients (>70 years) had significantly higher average hematoma volume (old: 62.2 mL vs. young 46.8 mL, P < 0.0001), lower average MLS (old: 6.6 mm vs. young: 7.4 mm, P= 0.025), and lower average MLS:hematoma volume ratio (old: 0.11 mm/mL vs. young 0.15 mm/mL, P < 0.0001). Young patients had an average of 1.5 mm greater MLS for a given hematoma volume in comparison to old patients. With increasing age, the ratio between MLS and hematoma volume significantly decreases (P= 0.0002). Commercially available, automated, artificial intelligence (AI)-based tools may be used for obtaining quantitative radiographic measurement data in patients with acute subdural hematoma. Our quantitative results are consistent with the qualitative relationship previously established between age, hematoma volume, and MLS, which supports the validity of using AI-based tools for acute subdural hematoma volume estimation.

Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma: Updated meta-analysis of real-world clinical outcome after RESCUE-ASDH trial.

The RESCUE-ASDH trial found that disability and quality-of-life outcomes were similar between craniotomy and decompressive craniectomy for traumatic acute subdural hematoma, contrasting previous literature. This meta-analysis aims to validate the applicability of RESCUE-ASDH results using real-world data in acute subdural hematoma patients. We searched Chocrane, Embase, and MEDLINE for relevant articles reporting clinical outcomes of craniotomy and decompressive craniectomy. Meta-analysis utilized R software with the restricted maximum likelihood method for random-effects meta-analyses, presenting odds ratios and 95% confidence intervals with Hartung-Knapp-Sidik-Jonkman adjustment for heterogeneity. Besides RESCUE-ASDH, 5 retrospective studies were included, spanning 2006-2016. A total of 961 patients with traumatic ASDH were included in this study (Craniotomy = 467; Decompressive craniotomy = 494). The pooled analysis of retrospective studies showed no significant difference in poor clinical outcomes between the two groups (OR 0.59, 95% CI, 0.32 to 1.10). These findings align with the RESCUE-ASDH trial (OR 0.84, 95% CI, 0.58 to 1.23). Mortality rate was significant higher in patients undergoing craniectomy in pooled result of retrospective studies (OR 0.59, 95% CI, 0.32 to 1.10). In RESCUE-ASDH trial, reoperation rate was higher in the craniotomy group, but the pooled result of retrospective did not show significant difference between the craniotomy and craniectomy group. This real-world evidence confirms the RESCUE-ASDH trial results. Both craniotomy and decompressive craniectomy yielded similar disability and quality-of-life outcomes for traumatic acute subdural hematoma patients. Level 2, Systematic and meta-analysis.

Factors Predicting Outcome of Surgically Treated Acute Subdural Hematoma

Objective: The study aimed to evaluate operative mortality and prognosis factors in posttraumatic acute subdural hematoma patients. Material &amp; Methods: A prospective cross-sectional study was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad. 82 patients operated for Acute Subdural Hematoma were included in the study. Variables that influence the outcome were recorded. The outcome was measured in terms of mortality. Results: Of 82 patients operated on, 61 were male, and 21 were female. 51 were &lt;40 old years, 21 were aged 41-60, and 7 were over 60. The most common cause is fall from height (47.6%). Cerebral contusion is often associated (28%). Overall mortality: 39.2%. Male mortality: 29.2%, female: 9.7%. Surgery &gt;4 hours post-injury had higher mortality (18.2%) vs. &lt;4 hours (8.5%). 14/43 GCS &lt;8 patients survived, with no deaths when GCS &gt;12. Pupillary abnormalities had higher mortality (31.9%) vs. normal pupils (7.3%). No deaths with hematoma thickness &lt;10mm and only 1 survived with a thickness &gt;16mm. 25/29 died with midline shift &gt;11mm. Conclusion: Prognostic factors for surgically treated traumatic acute subdural hematoma include GCS at presentation, pupils, hematoma thickness, midline shift, and time to surgery. Better outcomes associated with GCS&gt;9, normal pupils, hematoma width &lt;1.5cm, midline shift &lt;1cm, and surgery within 4 hours.

The effects of hematological parameters and anticoagulant/antiaggregant use on surgical outcomes in acute subdural hematoma

Objective: This study aims to investigate the effect of hematologic parameters including International Normalized Ratio (INR), platelet (Plt), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), leukocyte, neutrophil, lymphocyte, C-Reactive Protein (CRP) on the outcomes of surgical treatment of acute subdural hematoma.&#x0D; Material and Methods: The file data of 31 cases who were operated on with the diagnosis of Acute Subdural Hematoma (ASDH) at the Private Ankara Güven Hospital Neurosurgery Clinic between 01.01.2019 and 31.12.2021 were examined retrospectively. The ages, genders, history of anticoagulant/antiaggregant use, INR, platelet, hemoglobin, hematocrit, leukocyte, and CRP values of patients were recorded, and their relationships with re-bleeding, number of surgeries performed, and mortality were evaluated statistically.&#x0D; Results: The study was conducted with a total of 31 cases (35.5% (n=11) female and 64.5% (n=20) male). The average age of the cases was 72 (45-93). A single surgery was performed in 23 cases (74.2%), 8 patients (25.8%) were operated on again because of re-bleeding, and 9 of the cases (29%) died following the surgery. Among the 9 patients who died, 5 (55.5%) underwent single surgery and 4 (44.5%) underwent more than one surgery. The number of cases not using pre-operative anticoagulants/antiaggregants was 10 (32.3%), 9 (29%) patients were using anticoagulants, 7 patients (22.6%) were using single antiaggregant, and 5 patients (16.1%) were using dual antiaggregants. It was detected as statistically significant that the preoperative INR, leukocyte, and neutrophil counts of the patients who underwent multiple surgeries were detected to be higher than those of ASDH patients who underwent single surgery.&#x0D; Conclusion: Although pre-operative INR, leukocyte, and neutrophil elevation are not associated with mortality, these parameters can be associated with the requirement for re-surgery because of re-bleeding.&#x0D; Key words: re-bleeding, subdural hematoma, mortality, leukocyte, neutrophil

Postoperative Radiological Factors Associated with Early Mortality after Decompressive Craniectomy in Acute Subdural Hematoma

Background: Acute subdural hematoma (SDH) often leads to serious neurological deterioration or death. Patients with acute SDH are recommended decompressive craniectomy (DC) if their brain edema is severe. We investigated the association with early mortality through postoperative radiological studies after surgery.Methods: We retrospectively reviewed 31 out of 85 patients that underwent DC due to acute SDH at our neurosurgical department in January 2011–December 2020. The effect of decompression was estimated through comparison with preoperative and postoperative midline shift (MS) in brain computed tomography (CT). Brain edema was represented as an increased value, measured by comparing the lateral displaced parenchymal diameter with the normal brain diameter.Results: Of the total 31 patients, 15 died during hospitalization (group A) and 16 had the same or improved neurological status (group B). The reduction rate of MS was shown as higher in group B than in group A; it was significantly different between the two groups. The difference between the two values (DBD) was calculated by measuring the brain diameter of the operative site after DC and normal brain diameter for the progress of brain edema. The difference value of MS (DMS) was greater than DBD for 33.3% and 81.3% of group A and B patients, respectively. Conclusion: A lower MS reduction rate or higher DBD than DMS increases a patient’s early mortality rate. Therefore, early mortality in acute SDH patients who underwent DC could be predicted through analysis of postoperative brain CT.

Travmatik Akut Subdural Hematom ve İnmelerde Dekompresif Kraniektomi Sonrası Kısa Dönem Prognoz ve Mortalite Riskinin Olası Belirteçleri

Objective: Decompressive craniectomy can reduce mortality in selected patients with stroke and traumatic acute subdural hematoma. This study aimed to explore predictive markers for short-term prognosis and mortality risk in patients who underwent decompressive craniectomy due to traumatic acute subdural hematoma or malignant middle cerebral artery occlusion using clinical, radiological, and routine blood biochemistry findings.Material and Methods: Eleven traumatic acute subdural hematoma patients and 11 stroke patients were included in this study. On admission to hospital, for each patient, age, gender, Glasgow Coma Scale scores, anisocoria, time elapsed for decompressive craniectomy administration, midline shift level, duration of stay in Intensive Care Unit and in hospital, and Glasgow Outcome Scale scores on discharge from hospital and blood biochemistry findings were examined.Results: The Glasgow Outcome Scale score was found 3.5 (2-5) in surviving patients and it was seen that short-term prognosis of patients could be associated with lymphocyte, neutrophil, and platelet count, neutrophil-lymphocyte ratio, and serum C-reactive protein level. However, mortality rate in both groups was found 77.2%, and it was thought that age, leukocyte, monocyte and platelet count, and serum blood urea nitrogen level could be associated with mortality risk.Conclusion: As a result, it could be said that decompressive craniectomy could not reduce mortality risk in both groups. However, it was suggested that lymphocyte, neutrophil, and platelet counts, neutrophil-lymphocyte ratio, and serum C-reactive protein levels could be assumed as markers for short-term prognosis. Furthermore, it was concluded that age, leukocyte, monocyte, and platelet counts, and serum blood urea nitrogen levels could be predictors of mortality risk.

Age, Gender and Common Site of Haematoma Formation among Acute Subdural Hematoma Patients: Experience of 48 Cases in Bangladesh

Background: Acute subdural hematoma can occurs in different age group of patients in both male and female.&#x0D; Objective: The purpose of the present study was to observe the age and gender distribution among acute subdural hematoma patients.&#x0D; Methodology: This cross-sectional study was carried out in the Neurosurgery Department of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2011 to August 2012 for a period of one year and eight months. Patients with acute subdural hematoma who fulfil the inclusion criteria for surgery and got admitted were selected as study population. Acute Subdural hematoma patient of any age, both sex with GCS 5 to 13, thickness of hematoma more than l0 mm, midline shift more than 5 mm, pupil reacting to light and patient presented within 72 hours of injury were included for this study. At admission, a detailed history of the illness was taken from the patient or attendant, thorough general and neurological examinations were carried out and were recorded.&#x0D; Result: A total number of 48 patients were recruited for this current study. The mean age of the patients was 32.39±11.63 years and their age ranged from 10 to 56 years. The male and female ratio was 5:1. Out of 48 patients 17(31.25%) cases were fronto-temporal. Temporo-parietal were 16(33.3%) patients. Fronto-temporo-parietal were 7(14.5%) cases. Parietal were 5(10.41%) cases. Frontal were 3 (6.25%) case.&#x0D; Conclusion: In conclusion majority of the patients are male young adults presented with fronto-temporal and temporo-parietal region of shull.&#x0D; Journal of Science Foundation 2019;17(2):54-57

Clinical characteristics of the acute subdural hematoma patients taking antithrombotics: Retrospective analysis at a single center

Clinical characteristics of the acute subdural hematoma patients taking antithrombotics: Retrospective analysis at a single center

Acute and Subacute Deterioration in Elderly Acute Subdural Hematoma Patients Who Were Initially Managed with Non-Surgical Treatment

Acute and Subacute Deterioration in Elderly Acute Subdural Hematoma Patients Who Were Initially Managed with Non-Surgical Treatment

Value of Adding Cisternostomy to Decompressive Hemicraniectomy in the Management of Traumatic Acute Subdural Hematoma Patients

BACKGROUND: Surgical evacuation of acute subdural hematoma has remained the mainstay of the treatment for acute subdural hematoma (ASDH) in patients with progressive neurological deficits, increasing intracranial pressure (ICP), or significant mass effect. Cisternostomy entails opening the basal cisterns aiming to their opening to atmospheric pressure and therefore reducing the intraparenchymal pressure.&#x0D; AIM: We aimed to evaluate value of adding cisternostomy to decompressive craniotomy on outcome of traumatic ASDH patients.&#x0D; METHODS: Prospective study included 40 patients who presented to Cairo University hospital emergency department with traumatic acute subdural hematoma in the period between January 2018 and June 2019 and matching our inclusion criteria: Age from 12 to 65 years, traumatic acute subdural hematoma with thickness ≥ 10 mm or midline shift ≥ 5 mm, and Glasgow Coma Scale (GCS) on admission &lt; 10, with no associated intraparenchymal hematoma ≥ 1 cm or severe comorbidities. Patients were randomized into one of two groups according to their order of coming. The first group patients were operated on by decompressive craniotomy (DHC) plus cisternostomy and the second group was operated on by decompressive craniotomy only. Glasgow Outcome Score (GOS) was used for outcome assessment.&#x0D; RESULTS: Outcome was better 2nd but not statistically significant – in the first group (DHC+ cisternostomy) in terms of mortality: 7/20 patients (35%) (p = 0.337) and median GOS: 3 (p = 0.337), compared to the second group (DHC only) in which mortality occurred in 10/20 (50%) and median GOS was 1. Adding cisternostomy to decompressive craniotomy increased surgery time with 35.5 minutes in average. In our study, older age and lower GCS on admission had significantly worse outcome.&#x0D; CONCLUSION: Adding cisternostomy to decompressive craniotomy in traumatic patients had better 2nd but not statistically significant outcome. Whether it should replace the routine decompressive craniotomy in these cases or not needs further larger clinical trials.

Visualization of cortical cerebral blood flow dynamics during craniotomy in acute subdural hematoma using laser speckle imaging in a rat model

Mass evacuation with decompressive craniotomy is considered a standard intervention for acute subdural hematoma (ASDH). However, hemispheric swelling complicates the intraoperative and postoperative management of ASDH patients, and previous studies have revealed that this approach can damage ischemic/reperfusion (I/R) injury. Few studies have focused on the cerebrovascular response following traumatic brain injury (TBI). To characterize the relative cerebral blood flow (rCBF) before and after removal of the hematoma, rats were injured by a subdural infusion of 400 μL of venous blood or paraffin oil. MRI scans were performed. Then, we monitored cortical rCBF during hematoma removal in real time using laser speckle imaging (LSCI) in ASDH rats. The CBF of arteriovenous and capillary regions were quantified and normalized to their own baseline values via a custom algorithm. In the sham group, the cortical CBF was higher post-craniotomy than pre-craniotomy. However, in the hematoma injection group, the CBF of arteries and capillaries was higher while the venous CBF was lower post-craniotomy than pre-craniotomy. The difference in the changes in vein CBF that occurred between the two groups was statistically significant. The three components of the vascular system showed heterogeneous responses to craniotomy, which may be the basis for secondary brain injury.

Fifteen Cases of Endoscopic Treatment of Acute Subdural Hematoma with Small Craniotomy under Local Anesthesia: Endoscopic Hematoma Removal Reduces the Intraoperative Bleeding Amount and the Operative Time Compared with Craniotomy in Patients Aged 70 or Older.

We report cases of acute subdural hematoma (ASDH) treated by endoscopic hematoma removal with a small craniotomy under local anesthesia. From 2015 to 2019, we retrospectively analyzed 15 ASDH patients who were 70 years or older and met our criteria for endoscopic treatment: (1) comorbidities indicated risks associated with a large craniotomy under general anesthesia; (2) decompressive craniectomy was unlikely; and (3) an enlarging hematoma was absent. We also performed a case–control study using the inverse probability weighting method to compare the 15 patients to 20 ASDH patients who were 70 years or older, met criteria (2) and (3), and were treated by craniotomy between 2012 and 2019. Among the 15 ASDH patients, the median age was 86 (range, 70–101) years, and fall was the common cause. The median Glasgow Coma Scale score on admission, operative time, stay time in the operation room, and bleeding amount were 8 (6–15), 91 (48–156) min, 120 (80–205) min, and 20 (5–400) mL, respectively. The extraction rates of all the hematomas exceeded 90%. No patients required conversion to craniotomy under general anesthesia. Three patients had favorable outcomes, and five died. The comparison with craniotomy revealed that the endoscopic procedure reduced the intraoperative bleeding amount, operative time, and stay time in the operation room (p <0.001, p = 0.02, and p <0.001, respectively). In summary, endoscopic hematoma removal for selected ASDH patients aged 70 years or older did not improve functional outcomes but reduced the bleeding amount and the operative time compared with craniotomy.

Factors Associated with Poor Outcomes in Patients with Mild or Moderate Acute Subdural Hematomas.

The factors influencing the outcomes of mild/moderate acute subdural hematoma (ASDH) are still unclear. Retrospective analyses were performed to identify such factors. The medical records of all patients who were admitted to Saiseikai Shiga Hospital with mild (Glasgow Coma Scale [GCS] score of 14–15) or moderate (GCS score of 9–13) ASDH between April 2008 and March 2017 were reviewed. Comparisons between the patients who exhibited favorable and poor outcomes were performed. Then, independent factors that contributed to poor outcomes were identified via logistic regression analyses. A total of 266 patients with a mean age of 70.2 were included in this study. The most common concomitant injuries were subarachnoid hemorrhages (SAHs; 56.8%). The patients’ Injury Severity Scores (ISS) ranged from 16 to 75 (median: 21). The 66 moderate ASDH patients exhibited significantly higher frequencies of surgery and mortality (24.2% and 13.6%, respectively) than the 200 mild ASDH patients (8.0% and 4.5%, respectively). The factors associated with poor outcomes were age (odds ratio [OR]: 1.06) and the ISS (OR: 1.24) in the mild ASDH patients, and older age (OR: 1.09) and the higher ISS (OR: 1.15) in the moderate group, too.

Neurocritical Management of Traumatic Acute Subdural Hematomas.

Acute subdural hematoma (ASDH) has been a major part of traumatic brain injury. Intracranial hypertension may be followed by ASDH and brain edema. Regardless of the complicated pathophysiology of ASDH, the extent of primary brain injury underlying the ASDH is the most important factor affecting outcome. Ongoing intracranial pressure (ICP) increasing lead to cerebral perfusion pressure (CPP) decrease and cerebral blood flow (CBF) decreasing occurred by CPP decrease. In additionally, disruption of cerebral autoregulation, vasospasm, decreasing of metabolic demand may lead to CBF decreasing. Various protocols for ICP lowering were introduced in neuro-trauma field. Usage of anti-epileptic drugs (AEDs) for ASDH patients have controversy. AEDs may reduce the risk of early seizure (<7 days), but, does not for late-onset epilepsy. Usage of anticoagulants/antiplatelets is increasing due to life-long medical disease conditions in aging populations. It makes a difficulty to decide the proper management. Tranexamic acid may use to reducing bleeding and reduce ASDH related death rate. Decompressive craniectomy for ASDH can reduce patient's death rate. However, it may be accompanied with surgical risks due to big operation and additional cranioplasty afterwards. If the craniotomy is a sufficient management for the ASDH, endoscopic surgery will be good alternative to a conventional larger craniotomy to evacuate the hematoma. The management plan for the ASDH should be individualized based on age, neurologic status, radiologic findings, and the patient's conditions.

Analysis on clinical characteristics of rapid and non-rapid resolution of traumatic acute subdural hematoma

Objective To compare the clinical and imaging characteristics of traumatic acute subdural hematoma acute subdural hematoma with rapid resolution and those without rapid resolution. Methods A retrospective case-control analysis was conducted on the clinical data of 60 traumatic acute subdural hematoma patients with hematoma thickness≥5 mm admitted to Second Affiliated Hospital of Shantou University Medical College from January 2011 to May 2018. There were 37 males and 23 females, aged 18-80 years [(47.0±16.9)years]. There were 27 patients in the rapid resolution group and 33 patients in the non-rapid resolution group. Coagulation function [prothrombin time (PT) and international normalized ratio (INR)] on admission, hospital stay, Glasgow outcome scale (GOS), and brain CT results were compared between the two groups. Results The PT and INR values in the rapid resolution group were (11.9±2.1)s and 1.1±0.2 respectively, while those in the non-rapid resolution group were (10.8±1.0)s and 1.0±0.1 respectively, with significant differences (P 0.05). The thickness of subdural hematoma of the two groups in the first CT scanning was (8.2±2.3)mm and (7.3±1.8)mm, respectively, with no statistically significant difference (P>0.05). In the second CT scanning, the hematoma thickness in the rapid resolution group was significantly lower than that in the non-rapid resolution group [(2.7±1.9)mm vs. (6.6±2.1)mm] (P<0.01). The incidence of low density zone between the hematoma and intracranial plate was statistically higher in rapid resolution group than that in non-rapid resolution group (93% vs. 36%) (P<0.01). The incidence of subarachnoid hemorrhage(SAH) increase was significantly higher in rapid resolution group than that in non-rapid resolution group in the second CT scan (74% vs. 15%) (P<0.01). The conversion rate of acute subdural hematoma to subacute or chronic subdural hematoma was 4% in the rapid resolution group, which was significantly lower than 18% in the non rapid resolution group (P<0.05). Conclusions The abnormal coagulation function and low density zone indicated by CT are two important indicators of rapid resolution in patients with traumatic acute subdural hematoma. The risk of conversion from acute into subacute or chronic subdural hematoma is lower in rapid resolution of traumatic acute subdural hematoma, suggesting that rapid resolution may be one of the prognostic indicators of ASDH patients. Key words: Hematoma, subdural, acute; Tomography, spiral computed; Rapid spontaneous resolution

Delayed Operation of Acute Subdural Hematoma in Subacute Stage by Trephine Drainage using Urokinase.

ObjectiveThe principle operation of acute subdural hematoma (ASDH) is a craniotomy with hematoma removal, but a trephination with hematoma evacuation may be another method in selected cases. Trephine drainage was performed for ASDH patients in subacute stage using urokinase (UK) instillation, and its results were evaluated.MethodsBetween January 2016 and December 2018, the trephine evacuation using UK was performed in 9 patients. The interval between injury and operation was from 1 to 2 weeks. We underwent a burr hole trephination with drainage initially, and waited until the flow of liquefied hematoma stopped, then instilled UK for the purpose of clot liquefaction.ResultsThe mean age of patients was 71.6 years (range, 38–90 years). The cause of ASDH was trauma in 8 cases, and supposed a complication of anticoagulant medication in 1 case. Four out of 8 patients took antiplatelet medications and one of them was a chronic alcoholism. The range of the Glasgow Coma Scale score before surgery was from 13 to 15. Most of patients, main symptom was headache at admission. The Glasgow Outcome Scale score was 5 in 8 cases and 3 in 1 case.ConclusionIt is thought to be a useful operation method in selected patients with ASDH that the subdural drainage in subacute stage with UK instillation. This method might be another useful option for the patients with good mental state regardless of age and the patients with a risk of bleeding due to antithrombotic medications.

Comparison of Decompressive Craniotomy by Wide Opening of Dura with Multidural Fenestrations Technique among Acute Subdural Hematoma Patients: A Randomized Control Trial

Background: Surgical treatment is very crucial for the acute subdural hematoma patients.Objective: The purpose of the present study was to compare outcome of decompressive craniotomy with wide opening of dura and multidural fenestration technique.Methodology: This non-randomized clinical trial was carried out in the Neurosurgery Department of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2011 to August 2012 for a period of one year and eight months. Patients with acute subdural hematoma who fulfil the inclusion criteria for surgery and got admitted were selected as study population. Acute Subdural hematoma patient of any age, both sex with GCS 5 to 13, thickness of hematoma more than l0 mm, midline shift more than 5 mm, pupil reacting to light and patient presented within 72 hours of injury were included for this study. At admission, a detailed history of the illness was taken from the patient or attendant, thorough general and neurological examinations were carried out and were recorded. Specific treatment of head injury started and surgery done, cases were divided into two groups on the basis of surgical technique. Operative details, regular follow-up and post-operative CT scan findings were recorded. Finally GOS scoring done on the day of discharge of patient from the hospital.Result: A total number of 48 patients were recruited of this study of which 25 were in group A and the rest 23 patients were in group B. In group A, according to GOS Score, good recovery was 48%, moderate disability 16%, severe disability (8%), persistent vegetative state 4% and 24% patients died. In group B, good recovery was 47.83%, moderate disability 13.04%, severe disability 4.35%, persistent vegetative state 13.04% and 21.74% patients died. The mean duration of surgery was l26.32±24.86 minutes in group A and 90.95±l8.64 in group B and this difference was highly significant (P&lt;0.00l). In addition, the mean duration of hospital stay was 23.44(±6.65) days in group A and 16.26(±4.63) days in group B and this difference between two group was statistically significant (P&lt;0.001).Conclusion: In conclusion multiple dural fenestrations is an effective decompressive procedure for removal of acute subdural hematomaJournal of National Institute of Neurosciences Bangladesh, 2018;4(2): 75-81

The Optimal Operative Timing of Traumatic Intracranial Acute Subdural Hematoma Correlated with Outcome.

Objective:Acute subdural hematoma (ASDH) has been associated with mortality in traumatic brain injury. The timing of surgical evacuation for ASDH has still been controversial. The object of this study was to determine the temporal and clinical factors associated with outcome following surgery for ASDH.Materials and Methods:The study retrospectively viewed medical records and neuroimaging studies of ASDH patients who underwent surgical evacuation. Surgical outcomes were dichotomized into favorable and unfavorable outcomes, and operative times compared between the groups.Results:The records of 145 ASDH patients who underwent surgery were reviewed. Almost two-thirds of the patients were admitted for surgical evacuation, of whom 71% underwent a decompressive operation. The temporal variables were as follows: mean time from scene of accident to emergency department (ED) was 70 (Standard deviation [SD] 256.0) min, mean time from ED to obtaining CT of the brain was 45.6 (SD 38.9) min, mean time from brain computed tomographic to operating room arrival was 68.6 (SD 50.0) min, and mean time from ED arrival to skin incision was 160.1 (SD 88.1) min. The mean time from ED arrival to skin incision was significantly shorter in the unfavorable outcome group. Because of this reverse association between time from ED to surgery, multivariate analysis was applied to adjust the timing factors with other clinical factors, and the results indicated that temporal factors were not associated with functional outcome, as features such as increased intracranial pressure due to obliterated basal cistern and brain herniation were significantly associated with functional outcome.Conclusions:The optimal times for surgical evacuation of ASDH are challenging to estimate because compressed brainstem signs are more important than time factors. ASDH patients with compressed brainstem should have surgery as soon as possible.

The clinical relevance of ABO blood type in 100 patients with acute subdural hematoma.

ObjectiveThe correlation of depleted blood through midline shift in acute subdural hematoma remains the most reliable clinical predictor to date. On the other hand, patient’s ABO blood type has a profound impact on coagulation and hemostasis. We conducted this study to evaluate the role of patient’s blood type in terms of incidence, clinical course and outcome after acute subdural hematoma bleeding.Methods100 patients with acute subdural hematoma treated between 2010 and 2015 at the author’s institution were included. Baseline characteristics and clinical findings including Glasgow coma scale, Glasgow outcome scale, hematoma volume, rebleeding, midline shift, postoperative seizures and the presence of anticoagulation were analyzed for their association with ABO blood type.ResultsPatient’s with blood type O were found to have a lower midline shift (p<0.01) and significantly less seizures (OR: 0.43; p<0.05) compared to non-O patients. Furthermore, patients with blood type A had the a significantly higher midline shift (p<0.05) and a significantly increased risk for postoperative seizures (OR: 4.01; p<0.001). There was no difference in ABO blood type distribution between acute subdural hematoma patients and the average population.ConclusionThe ABO blood type has significant influence on acute subdural hematoma sequelae. Patient’s with blood type O benefit in their clinical course after acute subdural hematoma whereas blood type A patients are at highest risk for increased midline shift and postoperative seizures. Further studies elucidating the biological mechanisms of blood type depended hemostaseology and its role in acute subdural hematoma are required for the development of an appropriate intervention.

Endoscopic hematoma evacuation following emergent burr hole surgery for acute subdural hematoma in critical conditions: Technical note

Abstract Background Acute subdural hematoma (ASDH) is generally managed by large craniotomy with extended operating time and high relative blood loss. Recently, minimally invasive endoscopic hematoma evacuation of ASDH has been successfully demonstrated; however, non-elderly patients, moderate or massive cerebral contusion, and enlarging hematoma are generally not accepted as indications for endoscopic surgery. Clinical presentation We report our experience with two ASDH patients with impending herniation successfully evacuated via an endoscopic surgery following emergent burr hole craniostomy. Case 1: A 70-year-old man was admitted to our hospital because of severe head trauma. Neurological examination demonstrated a fixed, dilated right pupil and a CT scan showed ASDH. The entire procedure was completed in approximately 2.5 h. He was transferred to a rehabilitation hospital. Case 2: A 51-year-old comatose woman was transferred to our hospital after a motor vehicle accident. Radiological examination revealed ASDH and severe multiple trauma. Acute traumatic coagulopathy was confirmed by laboratory tests. The entire procedure was completed in approximately 1.5 h. Almost complete evacuation of the hematoma was achieved. Conclusion If intracranial pressure becomes sufficiently low after emergent burr hole craniostomy, endoscopic hematoma evacuation of ASDH may be a safe and effective method even in critically injured patients.