Hematoma Evacuation Research Articles

Subdural hematomas (SDHs) in infants present diagnostic challenges due to their diverse aetiologies ranging from non-accidental injury to metabolic or coagulopathic disorders. Clinical presentation includes vomiting, irritability, and bulging fontanelles. There are multiple surgical and non-surgical options available for management aimed at relieving mass effect. We report the unusual development of acute ventriculomegaly and downward gaze palsy in a clinically well 9-week-old boy following evacuation of bilateral subacute subdural hematomas. Neuroimaging revealed ventricular enlargement without other overt clinical features of hydrocephalus, and the symptoms resolved without CSF diversion. We hypothesize that the ventriculomegaly and downward gaze deviation were caused by altered CSF pressure gradient due to communication between the subarachnoid, subdural, and subgaleal spaces.

Non-traumatic subdural hematomas (NSDH) represent a rare but clinically significant pathology in the practice of neurologists and neurosurgeons. Establishing their non-traumatic origin often poses a challenge, especially in the absence of obvious risk factors, among which the leading ones are the use of antithrombotic therapy and advanced age of patients. Less common etiological factors include rupture of aneurysms, arteriovenous malformations and fistulas, as well as dural venous sinus thrombosis. Currently, there are no large case series dedicated to the management strategies of NSDH patients; therefore, indications for surgical treatment are based on recommendations for traumatic subdural hematomas. This article presents a literature review covering the period from 2000 to 2024, based on the Elibrary and PubMed databases, focusing on NSDH cases. Of the 119 publications screened, 36 met the inclusion criteria (strictly non-traumatic origin). The analysis allowed for the systematization of current data on the etiology, diagnosis, and treatment approaches for NSDH, emphasizing the importance of thorough angiographic examination to detect vascular anomalies, especially in young patients, and the necessity of correcting hemostatic disorders in the perioperative period. Furthermore, three original clinical cases are presented illustrating the course and outcomes of this condition in patients receiving dual antithrombotic therapy, where despite successful hematoma evacuation, a high risk of somatic complications was observed. Thus, the article summarizes contemporary understanding of the complex issue of NSDH, which holds significant practical value for improving diagnosis and treatment of this pathology.

ObjectiveThe study aimed to compare the effectiveness of endoscopic surgery assisted by 3D-Slicer with traditional craniotomy for treating basal ganglia hypertensive intracerebral hemorrhage (HICH).MethodsA total of 133 individuals diagnosed with hypertensive intracerebral hemorrhage in the basal ganglia region underwent surgical intervention in the Department of Neurosurgery at Affiliated Changshu Hospital of Nantong University from January 2018 to June 2023. Based on the surgical approach, participants were categorized into two cohorts: 76 patients who underwent endoscopic procedures and 57 who received traditional craniotomy. Postoperative hematoma clearance rates were quantified through volumetric analysis using 3D-Slicer software. Additionally, intergroup analyses were conducted to evaluate differences in surgical duration, hemorrhage volume during operation, Glasgow Coma Scale assessments at postoperative day 7, length of hospital stay and modified Rankin Scale score 3 months after surgery.ResultsThere were no statistically significant differences in preoperative baseline characteristics between the endoscopy and craniotomy groups (p > 0.05). However, the endoscopy group demonstrated superior surgical and clinical outcomes compared to the craniotomy group. Specifically, the endoscopy group achieved a significantly higher hematoma evacuation rate (90.0% ± 3.9% vs. 82.8% ± 4.9%, p < 0.01), a shorter operative time (1.5 ± 0.8 h vs. 4.9 ± 1.6 h, p < 0.01), and significantly reduced intraoperative blood loss (91.9 ± 89.1 mL vs. 593.6 ± 592.3 mL, p < 0.01). Postoperatively, the endoscopy group exhibited better neurological function, as indicated by higher Glasgow Coma Scale (GCS) scores (10.5 ± 2.3 vs. 7.9 ± 3.4, p < 0.01), and a shorter hospital stay (10.6 ± 5.8 days vs. 13.4 ± 8.2 days, p < 0.05). Postoperative modified Rankin Scale (mRS) score at 3 months were significantly better in the endoscopy group (3.4 ± 1.4 vs. 4.3 ± 1.7, p < 0.01) than in the craniotomy group. Endoscopic surgery was associated with more favorable outcomes, including higher hematoma clearance, reduced surgical duration and blood loss, improved neurological recovery, and faster postoperative rehabilitation compared to craniotomy. Data are presented as mean ± SD.ConclusionsEndoscopic procedures demonstrate superior clinical outcomes compared with conventional craniotomy for managing hypertensive intracerebral hemorrhage in the basal ganglia region, potentially enhancing patient recovery. This minimally invasive technique represents an advanced therapeutic approach for such cases. As endoscopic technology continues to evolve, its application in neurosurgical practice is expected to expand significantly. However, further validation through prospective randomized controlled studies remains essential to establish its efficacy conclusively.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-025-03276-y.

Efficacy Observation of Cranioplasty in the Treatment of Ruptured Middle Cranial Fossa Arachnoid Cyst with Cranial Deformity in Children.

Rationale:The co-occurrence of chronic subdural hematoma (CSDH) and spinal subdural hematoma (SSDH) is exceptionally rare, with ambiguous pathogenesis complicating management. This case aims to enhance understanding of its clinical trajectory, particularly the risk of intracranial progression after spinal surgery, which is critical for optimizing patient outcomes.Patient concerns:A 45-year-old woman presented with 3 days of severe lumbocrural pain and a 3-week history of headache after head trauma. She also reported 5 days of bowel dysfunction.Diagnoses:Lumbar magnetic resonance imaging revealed a lumbosacral SSDH (L2-S1). Cranial magnetic resonance imaging showed a right CSDH. Both hematomas were T1-isointense and T2-hyperintense without significant midline shift initially.Interventions:Oral atorvastatin (40 mg/day) was initiated for the CSDH. Emergency L4 hemilaminectomy for SSDH evacuation was performed due to intolerable pain and bowel dysfunction. On postoperative day 2, cranial CT showed CSDH progression with increased midline shift, prompting emergency burr-hole drainage.Outcomes:Lumbocrural pain resolved immediately postspinal surgery (visual analog scale: 9 to 2). Headache improved significantly postcranial drainage (numerical rating scale: 8 to 3). Bowel function normalized by discharge.Lessons:This case highlights that: SSDH can present with bowel dysfunction, a novel finding; postoperative intracranial hematoma progression is a real risk, necessitating vigilant neuroimaging surveillance after spinal evacuation; and the symptom sequence (cephalalgia preceding lumbalgia) supports the hematoma migration theory.

Severe intraventricular hemorrhage (SIVH; Graeb score ≥ 9) presents significant therapeutic challenges, including delayed hematoma resolution, CSF pathway obstruction, brainstem compression from fourth ventricular dilation, and infection risks associated with prolonged catheterization. This study evaluates the efficacy and safety of robot-assisted stereotactic minimally invasive aspiration and irrigation (RASMIAI) without fibrinolytic therapy as an alternative to conventional interventions. A retrospective analysis of 35 consecutive SIVH patients treated between January 2024 and January 2025 compared outcomes between RASMIAI group (n = 16) and conventional therapies (n = 19: stereotactic surgery, endoscopic evacuation, or external ventricular drainage [EVD]), as the control group. Procedural metrics, hematoma clearance, CSF circulation restoration, complications, mortality, and 90-day functional outcomes (mRS, GOS) were analyzed. Baseline demographics, Graeb scores, and Glasgow Coma Scale (GCS) scores were comparable between groups (p > 0.05). RASMIAI demonstrated superior procedural efficiency (47.2 ± 8.2 vs. 90.8 ± 51.4min, p = 0.002), with significantly higher 24-hour hematoma clearance (85.6 ± 9.6% vs. 38.4 ± 20.9%, p < 0.001) and faster CSF pathway restoration (1.3 ± 0.48 vs. 7.9 ± 2.4 days, p < 0.001). Postoperative imaging revealed near-complete hematoma resolution (Graeb score: 1.5 ± 0.97 vs. 6.1 ± 2.0, p < 0.001). The RASMIAI cohort exhibited no intracranial infections (0% vs. 31.6%, p = 0.014) and zero mortality at 90 days (0% vs. 36.8%, p = 0.007). Functional outcomes favored RASMIAI, with significantly improved the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) scores (p < 0.01). RASMIAI represents a paradigm shift in SIVH management, enabling simultaneous supratentorial and fourth ventricular hematoma evacuation without fibrinolytic agents. Its precision-driven approach reduces procedural time, enhances hematoma clearance, accelerates neurological recovery, and mitigates infection and mortality risks. These findings may indicate RASMIAI as a promising minimally invasive technique for severe IVH cases.

Objective To investigate the impact of neuroendoscopic surgery on surgical efficiency and long-term functional outcomes in patients with hypertensive intracerebral hemorrhage (HICH). Methods This retrospective comparative study was conducted on a cohort of 60 patients diagnosed with HICH who were admitted to Ganzhou People's Hospital between January 2020 and December 2022. The patients were divided into two groups based on the surgical technique employed: neuroendoscopic hematoma evacuation (NEHE, n = 30) and traditional craniotomy hematoma evacuation (CHE, n = 30). Primary outcomes measured included operative time, intraoperative blood loss, hematoma clearance rate, and long-term functional recovery assessed at the one-year follow-up using the Stroke-Specific Quality of Life Scale (SS-QOL), Modified Barthel Index (MBI), and Fugl-Meyer Assessment (FMA). Results The NEHE group demonstrated statistically significant improvements in surgical efficiency and safety. Specifically, the operative time was reduced by 25% (93.75 ± 10.56 min vs. 124.66 ± 21.71 min, p &amp;lt; 0.001), and intraoperative blood loss decreased by 44% (30.32 ± 5.63 mL vs. 53.75 ± 10.56 mL, p &amp;lt; 0.001), indicating markedly lower surgical trauma compared to CHE. Notably, the hematoma clearance rate in the NEHE group (84.66 ± 7.33%) surpassed that of CHE (80.21 ± 8.54%, p = 0.03), which may correlate with enhanced visualization of residual clots under endoscopic guidance. At 1-year follow-up, NEHE patients exhibited superior functional recovery, with SS-QOL scores increasing by 13% (156.74 ± 26.64 vs. 138.22 ± 34.45, p = 0.03), MBI scores by 20% (59.34 ± 11.51 vs. 49.22 ± 16.71, p = 0.01), and FMA scores by 23% (35.27 ± 3.98 vs. 28.63 ± 5.72, p &amp;lt; 0.001). Crucially, stratified analysis revealed maximal functional benefits in basal ganglia hemorrhages where FMA scores were 27% higher with NEHE (37.12 ± 3.15 vs. 29.23 ± 4.82, p &amp;lt; 0.001), contrasting with non-significant differences in lobar hemorrhages ( p = 0.41). Conclusion In summary, our findings affirm that NEHE provides superior surgical outcomes and a favorable safety profile in the management of HICH, with significant improvements noted in long-term quality of life and motor function. The results advocate for the adoption of NEHE as a primary approach for HICH cases.

Neutrophil-to-lymphocyte ratio (NLR) is a prognostic indicator in intracerebral hemorrhage (ICH) thought to reflect systemic inflammation driving secondary brain injury. Recent evidence suggests that surgical hematoma evacuation improves long-term outcomes, presumably by reducing secondary brain injury triggered by hematoma-induced inflammation. We hypothesized that stereotactic intracerebral hemorrhage underwater blood aspiration (SCUBA), a minimally invasive hematoma evacuation technique, alters the association between early rise in NLR and outcomes in ICH patients. We conducted a retrospective matched cohort study of 514 ICH patients: 264 underwent SCUBA and 250 were matched controls. Serial white blood cell (WBC) counts with differential were obtained from admission through hospital day 7. We analyzed relationships between the change in NLR from admission to hospital day 2 (delta NLR (ΔNLR)) and in-hospital mortality (primary outcome) using multivariable logistic regression, adjusting for ICH severity and infection status. Baseline characteristics, admission WBC count, and admission NLR were well-balanced without significant differences between groups. Hospital mortality was significantly lower in SCUBA patients (7.2% vs 22.8%, P<0.001). ΔNLR was independently associated with mortality (adjusted OR (aOR) 1.068 per unit increase, P=0.033). However, there was a significant interaction between SCUBA and ΔNLR (aOR 0.884, P=0.019). Predicted mortality probability remained low across NLR ranges in SCUBA patients while increasing sharply in the matched cohort. Our findings suggest that SCUBA modifies the association between ΔNLR and mortality, such that NLR was not a predictor of outcome after hematoma evacuation. Further work is needed to determine whether hematoma evacuation alters systemic inflammatory pathways that drive secondary brain injury after ICH.

ObjectiveTo compare the clinical efficacy, neurofactor changes, and prognosis in elderly patients with spontaneous intracerebral hemorrhage (ICH) treated with endoscopic surgery versus conventional craniotomy.MethodsA retrospective analysis was conducted on 88 elderly patients with spontaneous ICH admitted from July 2021 to April 2024. Based on surgical method, patients were assigned to either the conventional craniotomy group (n=44) or the endoscopic surgery group (n=44). Surgical efficacy (hematoma evacuation rate, surgical duration, intraoperative blood loss), short-term prognosis (ICU stay, hospital stay, GOS, NIHSS, ADL scores), serum neurofactors (SOD, NSE, NGF, BDNF), inflammatory markers (WBC, CRP, PCT), and complication rates were compared.Results(1) The endoscopic group had significantly shorter surgical time and lower blood loss than the craniotomy group (P<0.05), with similar hematoma evacuation rates (P>0.05). (2) ICU and hospital stays were significantly shorter in the endoscopic group (P<0.05). Postoperative GOS and ADL scores were higher, and NIHSS scores were lower in the endoscopic group at 3 months (P<0.05). (3) Compared with preoperative levels, both groups showed a decreasing trend in SOD and NSE and an increasing trend in NGF and BDNF after surgery, with the observation group showing more significant and sustained changes over time (P < 0.05). (4) Although postoperative inflammatory markers increased in both groups, the observation group had milder elevations and faster downward trends (P < 0.05). (5) The complication rate was lower in the endoscopic group (6.82% vs 22.73%, P<0.05).ConclusionCompared to conventional craniotomy, endoscopic hematoma evacuation in elderly ICH patients results in milder inflammatory responses, more favorable neurofactor changes, fewer complications, and improved recovery. However, these findings require further validation due to the retrospective design and limited sample size.

Penile fracture is an uncommon but well-recognized urological emergency characterized by rupture of the tunica albuginea of the corpora cavernosa following blunt trauma to the erect penis. We report the case of a 45-year-old man admitted four hours after sexual intercourse, presenting with an audible cracking sound, immediate pain, and sudden penile deformity. Clinical examination revealed diffuse ecchymosis, hemorrhagic swelling, and axial deviation. High-resolution ultrasound using a 7–12 MHz linear probe demonstrated a 23 mm ventrolateral rupture of the tunica albuginea of the left corpus cavernosum, associated with a heterogeneous para-cavernous hematoma. The contralateral corpus cavernosum, corpus spongiosum, and urethra were preserved. Color Doppler imaging showed no abnormal flow or arteriovenous fistula. Emergency surgical exploration allowed hematoma evacuation and tunical repair. Postoperative evolution was favorable, with resolution of edema, recovery of morning erections, and satisfactory erectile function. This case highlights the pivotal role of high-resolution ultrasound in diagnosing and localizing penile fractures, enabling prompt surgical repair that ensures optimal functional recovery and minimizes long-term complications.

Timing of surgical intervention for chronic subdural hematoma in patients undergoing middle meningeal artery embolization: A retrospective propensity score matched study.

One principle of facial aesthetics is based on "facial thirds," and hairline recession/large foreheads disrupt this balance. Hairline lowering can improve harmonious aesthetics and often uses bioabsorbable implants. This study seeks to establish the outcomes and stability of hairline lowering using the Endotine Forehead-mini in a single-surgeon cohort in the United States. This is a retrospective review of a single-surgeon cohort from 2011 to 2024 that underwent hairline lowering. Patient demographics, outcomes, and complications were documented. Upper facial third ratios were measured preoperatively and postoperatively and compared using paired t tests. The stability of the upper facial third ratio was assessed over time using paired t tests between the first postoperative visit and subsequent visits. 100 patients were included, with 58 having images available for analysis. 100% of patients had a statistically significant reduction in upper third percentage medially (μ = 3.5% lower, 95% CI = 3.1%-3.8%, p < 0.001) and laterally (μ = 3.1% lower, 95% CI = 2.7%-3.6%, p < 0.001) at their first postoperative visit. As patients travel for this procedure, follow-up varied; however, hairline lowering was stable from first follow-up to 3-6 months, 6-12 months, and past 12 months. Patient satisfaction appeared high but was not formally assessed. Complications occurred in 26% of patients: transient alopecia in 14% (all resolved with minoxidil), 10% required additional surgery (scar revision, further hairline lowering, or hematoma evacuation), 2% had hematomas managed nonsurgically, 5% had scalp irritation, and 1% had a postoperative infection (treated with antibiotics). Use of the Endotine Forehead-mini was associated with substantial, sustained hairline lowering with minimal risks.

To develop and validate a novel prediction model for venous thromboembolism (VTE) after hematoma evacuation in spontaneous intracerebral hemorrhage (sICH) patients.sICH patients who underwent hematoma evacuation from January 2022 to December 2024 were retrospectively analyzed in two tertiary hospitals. The cohort was divided into a development cohort and a validation cohort. Clinical data and laboratory test results were collected. Multivariate logistic regression was used to identify independent predictors of VTE at 30 days after surgery and Nomogram was constructed. The model performance was tested with the validation cohort and assessed using the C-index, calibration curve, Hosmer-Lemeshow test, decision curve analysis (DCA), and clinical impact curve (CIC).A total of 456 patients were enrolled in the study, 346 of whom were used in the training cohort and 110 in the validation cohort. The C-index and Brier score of the nomogram in the training set were 0.902 and 0.072, respectively, and the correction values after internal verification were 0.805 and 0.026, respectively. The calibration curve showed favorable consistency between the prediction of the nomogram and actual observations in both the training and validation cohorts. In addition, DCA and CIC confirmed the clinical utility of the nomogram constructed to predict postoperative VTE in sICH patients.This first surgery-specific nomogram integrates five perioperative variables to accurately predict VTE risk post-evacuation in sICH patients. It enables early targeted prophylaxis, potentially reducing preventable morbidity.

Computed tomography-guided intracerebral hematoma puncture is associated with issues such as significant localization errors and the need for multiple punctures. This study conducted a meta-analysis to systematically evaluate the differences in safety and accuracy between 3D printing guide plate localization and CT localization techniques in intracerebral hematoma evacuation procedures, providing evidence for primary care hospitals to adopt precise puncture techniques. A systematic search was conducted across 12 databases, including PubMed, the Cochrane Library, Web of Science, Embase, Scopus, and the China National Knowledge Infrastructure (CNKI). The quality of studies was assessed using the Newcastle-Ottawa Scale or the Methodological Index for Non-Randomized Studies, depending on the study design. Data analysis was performed using statistical software. A comprehensive analysis of 28 clinical studies involving 2319 patients revealed that 3D printing guide plate localization technology offers significant advantages over CT localization in intracerebral hematoma puncture treatment, including higher puncture accuracy (P ˂ 0.05), better postoperative neurological function recovery (postoperative Glasgow Coma Scale scores, P < 0.05), superior clinical efficacy (P ˂ 0.05), and higher single-puncture success rates (P ˂ 0.05). Although there were no significant differences between the two groups in terms of long-term outcomes (Glasgow Outcome Scale, P = 0.81), hematoma evacuation rate (P = 0.06), and complication incidence (P = 0.92), 3D printing technology significantly reduced mortality (P ˂ 0.05) and hospitalization costs (P ˂ 0.05). Current evidence suggests that 3D printing plate localization technique is a safer, more precise, and cost-effective approach for intracerebral hematoma puncture, especially applicable in primary care hospitals.

BackgroundIntracerebral hemorrhage (ICH) disproportionately affects low- and middle-income countries (LMICs), where prevalence and outcomes are poor. Surgical intervention is often necessary in life-threatening cases. This study explored the feasibility of using a low-cost, in-house tubular retractor for ICH evacuation in a resource-limited setting.MethodsWe retrospectively reviewed adults with spontaneous supratentorial ICH who underwent evacuation with an International Organization for Standardization (ISO)-compliant, in-house tubular retractor (production cost approximately $60) between January 2023 and June 2024. Outcomes included hematoma volume reduction, correction of midline shift, perioperative complications, reoperation, hospital stay, and Glasgow Coma Scale (GCS) scores at discharge and 6 months.ResultsA total of 18 patients (13 males, 5 females; mean age 60.6 ± 13.8 years) underwent surgery. Median hematoma volume was 65.3 cm3(IQR, 48.5–93.8), with a mean reduction of 81.2% ± 11.7 (median 83.9% [IQR 73.4–88.3]). Midline shift correction averaged 58.5% ± 28.0 (median 55.9% [IQR 43.7–69.6]). Hematoma evacuation was similar whether surgery occurred within 6 hours or later (79.8% vs. 83.5%,p = 0.49). Putaminal and frontal hematomas (n = 14) showed greater reduction than non-putaminal (n = 4), though not statistically significant. Median hospital stay was 23.5 days (IQR, 14.5–50.5). At 6 months, median GCS improved from 13 (IQR, 9–14) at discharge to 15 (IQR, 12–15). Two patients died of non-neurological causes.ConclusionUse of an in-house, ISO-compliant tubular retractor is feasible and cost-effective for intracerebral hematoma evacuation in resource-limited settings. These preliminary findings support further investigation to refine the technique and assess its clinical impact.

Rationale:In-hospital unexpected cerebral herniation (IHUCH) refers to abrupt, unanticipated cerebral herniation in patients who were previously considered stable. Its sudden onset may lead to delayed recognition and poor outcomes.Patient concerns:A 50-year-old man was transferred to our institution after a motor vehicle collision. The patient’s Glasgow Coma Scale score remained between 13 and 14 upon admission. At the sixth day, without warning, he acutely lost consciousness, dropping to Glasgow Coma Scale 6, with left pupillary dilatation and loss of light reflex.Diagnoses:Initial computed tomography revealed: left frontotemporal traumatic subdural hemorrhage, right-sided epidural hemorrhage, traumatic subarachnoid hemorrhage, right temporal bone fracture, left traumatic intraparenchymal hematoma, pneumocephalus, and basal skull fracture. Without surgical indications, day 6 emergency computed tomography demonstrated the compression of the left lateral ventricle with rightward midline shift, effacement of the suprasellar cistern and perimesencephalic cisterns, and marked cerebral edema.Interventions:Urgent left decompressive craniectomy with evacuation of subdural hematoma was performed. Postoperatively, the patient’s intracranial hypertension remained refractory. As conservative measures failed, a contralateral decompressive craniectomy was performed the next day, opposite the initial surgical site.Outcomes:Despite prompt surgical decompression, the patient remained in a persistent comatose state. After 5 months of comprehensive neuro-rehabilitation without neurological improvement, the family elected to withdraw life-sustaining treatment and the patient was discharged home.Lessons:This case illustrates how IHUCH can occur even under close neuro-monitoring. Key risk factors include postoperative hematoma recurrence, bilateral frontal lobe contusions, delayed traumatic intracranial hematoma, paradoxical cerebral herniation, chronic subdural hygroma, and tumor. Integrating IHUCH into neurosurgical quality control standards, augmented by continuous multimodal intracranial pressure monitoring, may enhance early detection and improve outcomes.

It is unclear whether performing surgery for most patients with an acute subdural hematoma (ASDH) and traumatic brain injury (TBI) is superior to conservative treatment. To compare the effectiveness of a strategy preferring acute surgical ASDH evacuation with one preferring initial conservative treatment. This comparative effectiveness study used data from February 1, 2014, to July 31, 2018, from the prospective observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study, conducted at 18 Level 1 trauma centers in the US. The study included patients with nonpenetrating TBI presenting to the emergency department and admitted within 24 hours after injury with ASDH detected on acute head computed tomography scan. Statistical analysis was performed from December 1, 2022, to December 20, 2024. Acute surgical hematoma evacuation vs initial conservative treatment, comparing outcomes between centers according to treatment preferences, measured by the case mix-adjusted probability of undergoing acute surgery (vs conservative treatment) per center. Functional disability at 6 months was assessed with the Glasgow Outcome Scale-Extended at 6 months, analyzed with ordinal logistic regression adjusted for prespecified confounders, quantified with a common odds ratio (OR). Variation in center preference was quantified with a median OR (MOR). Of 2697 included patients, 711 (mean [SD] age, 46.5 [19.4] years; 539 men [76%]) had an ASDH, of whom 148 (21%) underwent acute cranial surgery and 563 (79%) underwent initial conservative treatment. The acute surgery cohort had lower mean (SD) Glasgow Coma Scale scores (6.8 [4.4] vs 11.4 [4.6]), more pupil abnormalities (both pupils unreacting: 43 of 133 [32%] vs 41 of 477 [9%]), and fewer isolated ASDHs (eg, more with concurrent intracranial lesions; 92 of 133 [69%] vs 297 of 563 [53%%]) compared with the conservative treatment cohort. In the surgical cohort, 129 of 148 patients (87%) underwent decompressive craniectomy (DC), and 17 of 148 (11%) underwent craniotomy. In the conservative treatment cohort, 67 of 563 patients (12%) underwent delayed cranial surgery (DC or craniotomy). The proportion of patients undergoing acute surgery ranged from 0% to 86% (median, 17% [IQR, 5%-27%]) between centers, with up to a 3-fold higher probability of prognostically similar patients receiving acute surgery in one center compared with another random center (MOR, 2.95 [95% CI, 1.79-7.47]; P = .06). Center preference for acute surgery over initial conservative treatment was not associated with a better outcome (OR, 1.05 [95% CI, 0.88-1.26] per 22% [IQR, 5%-27%] increase in acute surgery at a given trauma center). In this comparative effectiveness study, similar patients with traumatic ASDH were treated differently due to center-specific treatment preferences. Outcomes were similar in centers preferring surgical evacuation and those preferring initial conservative treatment. This study suggests that, for a patient with ASDH for whom a neurosurgeon experiences clinical equipoise between acute surgery vs (initial) conservative treatment, conservative treatment may be considered.

24-Hour Observation After Thyroid and Parathyroid Surgery for Central Neck Hematomas: Is This Really Necessary?

We present 3 cases of brachial plexus injuries (BPI) secondary to compressive hematomas during extracorporeal membrane oxygenation (ECMO), with follow-up ranging from 18 months to 12 years. Patients exhibited profound upper extremity deficits and underwent variable interventions, including surgical decompression. All demonstrated meaningful neurologic recovery. BPI is a rare but serious complication of ECMO. These cases highlight the importance of early recognition and hematoma evacuation, emphasizing the need for clinical vigilance to optimize neurologic outcomes following hematoma-induced nerve injury.

One of our adult patients with polycythemia vera developed sciatic nerve palsy following a bone marrow aspiration (BMA). The patient was on oral anticoagulants and developed a large hematoma in the posterior thigh, resulting in sciatic nerve compression. Treatment involved hematoma evacuation and nerve decompression, which helped alleviate severe pain and enabled neurological recovery. Although BMA is generally a safe procedure, it can rarely lead to hemorrhage, particularly in patients with myeloproliferative disorders and those taking anticoagulants. It is crucial to be aware of this possibility, carefully select patients, and take precautions for individuals at high risk.