Craniotomy Versus Craniectomy for Acute Traumatic Subdural Hematoma in the United States: A National Retrospective Cohort Analysis

Rush, Barret; Rousseau, Justin F.; Sekhon, Mypinder S.; Griesdale, Donald

doi:10.1016/j.wneu.2015.12.034

Cited by 62 publications

(46 citation statements)

References 30 publications

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“…Craniectomy is associated with a significantly higher in-hospital mortality rate. 10 No comparative studies have been performed for craniotomy versus craniectomy. Of course, a large craniectomy is required when cerebral edema must be controlled.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Hwang

Shin

2019

J Neurol Surg A Cent Eur Neurosurg

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Background Endoscopic surgery is helpful in evacuating intracranial hematomas. However, the indication and the craniotomy location are still unclear in the endoscopic evacuation of acute subdural hematomas (SDHs). This study evaluated the feasibility and efficacy of endoscopic treatment of acute SDH via a normal small craniotomy. Methods A normal small craniotomy (∼ 3 × 4 cm) as a surgical window was made at the superior temporal line around the coronal suture on the lesion side. A 4-mm rigid endoscope with a 0-degree lens was introduced into the subdural space, and the hematoma was evacuated using irrigation and suction devices with various angles. Endoscopic surgery was performed in 13 older adult patients with acute SDH. Adequacy of the hematoma evacuation, bleeding control, and clinical outcomes were analyzed. Results The mean age of the patient was 78.6 years (range: 65–89 years). Four cases of cortical arterial bleeding were encountered and controlled with bipolar cauterization. No re-bleeding was observed postoperatively in any patient. Near-total hematoma removal was achieved. Remnant hematoma was scanty and located in the parietal area. No further craniectomy was required after the endoscopic surgery. The outcome at discharge was closely related to the patient's level of consciousness before the operation. Conclusion A small craniotomy around the superior temporal line provides an optimal window to evacuate an acute SDH and achieve hemostasis using an endoscope. Endoscopic evacuation of acute SDHs could be effective in selected cases.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Hwang

Shin

2019

J Neurol Surg A Cent Eur Neurosurg

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“…In conclusion, a simple decompressive craniectomy alone does not provide more benefit and an open dural flap is full of risk in such patients. [0][1][2][3][4][5][6][7][8][9][10][11][12] In a recent systematic literature review Barthélemy et al has evaluated decompressive craniectomy after severe TBI, by comparing the literature with first major RCT on this topic (DECRA). They found that when a comparison was done between Decompressive Craniectomy with multiple dural stabs and DC with open dural flap, dural stab group was found to have a significant advantage in mortality and GOS.…”

Section: Discussionmentioning

confidence: 99%

“…4 Different techniques can be employed for evacuation of symptomatic acute SDH, including decompressive craniectomy (DC), burr hole trephination or simple craniotomy and evacuation of hematoma, however, only few studies compares different surgical methods. 5 DC involves removal of skull bone along with clot, but without replacing the bone due to possible expansion of brain due to edema. In one technique Dura matter is widely opened in C shaped manner.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcome of Decompressive Craniectomy with Wide Dural Flap Duraplasty Versus Dural Slits in the Management of Post Traumatic Acute Subdural Hematoma in Terms of Postoperative CSF Leak

Abbas¹,

Khan²,

Zubair³

et al. 2019

Pak J Neurol Surg

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Objective: To compare the frequency of postoperative cerebrospinal fluid (CSF) leak after decompressive craniectomy with wide dural flap duraplasty versus dural slits in patients with post traumatic acute subdural hematoma.Material and Methods: The study was conducted from August 2017 to February 2018 in the Department of Neurosurgery, PIMS, Islamabad. A total of ninety-two (n = 92) adult patients of either gender between age 15-55 years presented with isolated, unilateral traumatic acute sub dural hematoma (ASDH) with midline shift of 5mm were categorized into 2 groups; Group A (DC with open dural flap) and Group B (DC with dural slits). Patients were observed for CSF leakage for four weeks.Results: Results showed that the overall frequency of CSF leak was not significantly different in both groups and revealed that the CSF leak was observed in 10.9% (n = 5/46) in group A (DC plus open dural flap) and in 21.7% (n = 10/46) in group B (DC plus dural slits) (P = 0.158). The difference was not significant in terms of frequency of CSF leak in both groups when results were stratified with respect to gender, age, duration of trauma and baseline GCS. P value (chi-square) was found to be > 0.05 in all cases.Conclusions: The postoperative CSF leak was observed in higher percentages in patients who underwent DC with dural slits as compared to the patients who underwent DC with open dural flaps for surgical management of ASDH. The difference, however, was not statistically significant.

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“…The mortality rates observed in previous studies with emergency surgery patients vary from 1.4% to 35.0%. (10,19,22,25) Some studies with emergency surgery patients analyzed factors associated with the risk of death: low scores in the GCS and anisocoria were identified as important factors associated with a worse prognosis. (6,9,20) Accordingly, in this study, patients who underwent emergency surgery had lower scores in the GCS compared to the elective surgery patients.…”

Section: Discussionmentioning

confidence: 99%

Complicações pós-operatórias em neurocirurgia eletiva e não eletiva

Siqueira

Diccini

2017

Acta paul. enferm.

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Objective: To evaluate the incidence of postoperative complications and mortality among patients submitted to elective or non-elective neurosurgery. Methods: Prospective cohort study in adult patients, followed from preoperative period until hospital discharge or death. Results: One hundred and twenty seven patients were included in elective surgery group and 75 patients in non-elective surgery group. The elective group had more vomiting (p=0.010) and pain (p<0.001) and the non-elective group presented more intracranial hypertension (p=0.001), anisocoria (p=0.002), cerebral vasospasm (p=0.043), light-unresponsive pupil (p=0.006) and reoperation (p=0.046). The mortality rate was 5.5% in the elective surgery group and 26.7% in the non-elective surgery group (p<0.001). Conclusion: Elective procedures in neurosurgery are related to higher frequencies of systemic complications while non-elective surgeries had significantly higher rates of neurological complications and mortality. ResumoObjetivo: Avaliar a incidência de complicações pós-operatorias e mortalidade entre pacientes submetidos a neurocirurcia eletiva e não eletiva. Metodos: Estudo de coorte prospectivo com pacientes adultos, acompanhados desde o período pré-operatório até a alta hospitalar ou óbito. Resultados: Foram incluídos 127 pacientes no grupo cirúrgico eletivo e 75 pacientes no grupo cirúrgico não eletivo. O grupo eletivo teve mais vômitos (p=0,010) e dor (p<0,001) e o grupo não eletivo apresentou mais hipertensão intracraniana (p=0,001), anisocoria (p=0,002), vasoespasmo cerebral (p=0,043), pupilas não fotorreagentes (p=0,006) e reoperação (p=0,046). A taxa de mortalidade foi de 5,5% no grupo de cirurgia eletiva e 26,7% no grupo de cirurgia não eletiva (p<0,001). Conclusão: Os procedimentos eletivos em neurocirurgia estão relacionados a maior frequência de complicações sistêmicas, enquanto as cirurgias não eletivas tiveram taxas significativamente mais altas de complicações neurológicas e mortalidade.

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Craniotomy Versus Craniectomy for Acute Traumatic Subdural Hematoma in the United States: A National Retrospective Cohort Analysis

Cited by 62 publications

References 30 publications

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Comparison of Outcome of Decompressive Craniectomy with Wide Dural Flap Duraplasty Versus Dural Slits in the Management of Post Traumatic Acute Subdural Hematoma in Terms of Postoperative CSF Leak

Complicações pós-operatórias em neurocirurgia eletiva e não eletiva

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