[Wide craniotomy-small dural incisions and intentionally delayed removal of intracerebral contusional hemorrhage for acute subdural hematoma].
The outcome of acute subdural hematoma (ASDH), which can cause severe parenchymal injury, has generally been unsatisfactory. The standard surgical procedure for ASDH is a quick and wide opening by dural incision, removal of the subdural and contusional intracerebral hematoma, followed by large external and internal decompression. In this study, we assessed our therapeutic strategy, consisting of three principles: 1. Removal of subdural hematoma by wide craniotomy-small dural incisions, in well-decompressed case, connecting the small dural incisions and stanching the bleeding points on the cortical surface but not proceeding with contusional hemorrhage in emergency operations, 2. Post-operative induction of mild barbiturate-moderate hypothermia therapy and 3. Intentionally delayed evacuation of the intracerebral contusional hemorrhage when needed. The patients, profile is composed of an old therapy group (27 cases) and a new therapy group (20 cases) suffering from ASDH with cerebral contusion. The clinical outcome with the old therapeutic strategy was good recovery (GR) in 7 cases, moderate disability (MD) in 5, severe disability (SD) in 2, vegetative state (PVS) in 3 and death (D) in 10, whereas the outcome with the new strategy resulted in GR in 15 cases, MD in 3, D in 2. These clinical results indicate that the rates of mortality and severe morbidity were markedly reduced with our new therapeutic strategy.
Young-Su
P
P
Department of Neurosurgery, Maizuru Municipal Hospital.
Ishikawa
J
J
D000208:Acute Disease; D000328:Adult; D001924:Brain Concussion / Q000150:complications*; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical; D004388:Dura Mater / Q000601:surgery; D006408:Hematoma, Subdural / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged