[Emergency drainage of acute intracranial hematomas with unsterile conditions during computerized tomography].
From January 1979 to December 1993, we treated 761 patients with epidural (n = 184) or subdural (n = 577) haematomas. Twenty-six were subjected to emergency trepanation on the CT-table, since their condition was considered life-threatening. All fulfilled the following criteria: 1. Glasgow Coma Score below 9, 2. Progressive coma and/or progressive anisocoria and/or 3. Other signs of acute life risk correlating with an intracranial haematoma. Nine of these 26 patients died (3 out of a total of 17 with epidural and 6 out of a total of 9 subdural haematomas). In 5 cases the cause of death was brainedema, in 3 cases a multiorgan failure, and one pneumonia. None of the patients acquired an infection at the trepanationsite or elsewhere within the CNS. Twelve patients had postoperative complications (8 with epidural and 4 with subdural haematoma). These caused a prolongation of the average hospitalization period. Patients with uncomplicated follow-up were discharged after 17.6 +/- 4.2 days, as opposed to 44.8 +/- 15.7 days for complicated cases. Six months following discharge 8 of 17 patients with an epidural haematoma had reached stage 5 of the Glasgow Outcome Scale, 4 were in stage 4, 1 in stage 3, and 1 in stage 2. Three patients had died. None of the 9 patients with a subdural haematoma had reached stage 5. One patient had reached stage 4, 2 stage 2, while 6 patients had died.
Brock
M
M
Abteilung für Neurochirurgie, Universitätsklinikum Benjamin Franklin, Freien Universität Berlin.
Ramsbacher
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014207:Trephining
Die Notentlastung akuter intrakranieller Hämatome unter unsterilen Bedingungen während der Computertomographie.