title: Surgical outcome following a decompressive craniectomy for acute epidural hematoma patients presenting with associated massive brain swelling.
abstract: Acute epidural hematomas (AEDH) are generally managed with rapid surgical hematoma evacuation and bleeding control. However, the surgical outcome of patients with serious brain edema is poor. This study reviewed the clinical outcome for AEDH patients and evaluated the efficacy of the DC, especially in patients with associated massive brain swelling. Eighty consecutive patients surgically treated with AEDH were retrospectively assessed. The patients were divided into two groups: (a) hematoma evacuation (HE: 46 cases) and (b) HE+ an external decompression (ED: 34 cases). The medical charts, operative findings, radiological findings, and operative notes were reviewed. In the poor outcome group, there were 18 patients (72%), with a GCS score of less than 8 (severe injury), and 22 patients (88%) who showed pupil abnormalities. Many more patients showed a midline shift, basal cistern effacement, and brain contusion in comparison to the favorable outcome group. In the favorable outcome group, almost all of the patients (98%) showed less than 12 mm of a midline shift. The influential factors may be age, GCS, pupil abnormalities, size, midline shift, basal cistern effacement, coincidence of contusion and swelling. We conclude that an A DC may be effective to manage the AEDH patients with cerebral contusion or massive brain swelling.
authors.affiliation: Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan. naotani@tdmc.hosp.go.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takasato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Masaoka
authors.forename: Takanori
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yoshino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsushige
authors.forename: Hiroki
authors.initials: H
authors.lastname: Miyawaki
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sumiyoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugawara
authors.forename: Aoyagi
authors.initials: A
authors.lastname: Chikashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Go
authors.initials: G
authors.lastname: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000150:complications* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult