title: Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma.
abstract: BACKGROUND
  Although rare, patients with acute subdural hematoma (ASDH) because of severe head injury can develop contralateral acute epi- or subdural hematoma, requiring consecutive surgical procedures. The choice of treatment strategies for such patients is clinically important.
  
  
  METHODS
  Among 88 patients with ASDH who were surgically treated over 13 years, we encountered and studied 5 patients who developed contralateral acute epi- or subdural hematoma (5.7%).
  
  
  RESULTS
  All 5 patients were male, ranging in age from 17 to 40. According to the Glasgow Coma Scale on admission, 1 patient was rated 3, 1 was 4, 1 was 5, and 2 were 6. All patients underwent consecutive surgical procedures for ASDH and contralateral ASDH and/or acute epidural hematoma, and were given postoperative supportive therapy with barbiturates and mild hypothermia. Patients' outcomes according to the Glasgow Outcome Scale were as follows: 1 patient, good recovery (20.0%); 1, mild disability (20.0%); 2, severe disability (40.0%), and 1, persistent vegetative state (20.0%). No patients died. Although decompressive craniectomy and evacuation of hematoma may lead to contralateral acute epi- or subdural hematoma in patients with ASDH, this therapy is justified because hematoma irrigation with trephination therapy has a poor outcome for comatose patients.
  
  
  CONCLUSIONS
  Awareness of intraoperative brain swelling is important, as it suggests the development of contralateral hematoma. Immediate computed tomography and a rapid return to the operating room are therefore critical.
authors.affiliation: Department of Neurosurgery, Teikyo University Ichihara Hospital, 3426 Anegasaki, Ichihara City, Chiba 299-0111, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsuno
authors.forename: Haruko
authors.initials: H
authors.lastname: Katayama
authors.forename: Hiromi
authors.initials: H
authors.lastname: Wada
authors.forename: Kentaro
authors.initials: K
authors.lastname: Morikawa
authors.forename: Kotaro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hideki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Mineko
authors.initials: M
authors.lastname: Murakami
authors.forename: Nobuo
authors.initials: N
authors.lastname: Fuke
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nagashima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D020199:Hematoma, Subdural, Acute / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014207:Trephining / Q000009:adverse effects*