title: Significance of monitoring the initial intracranial pressure on hematoma irrigation with trephination therapy for acute subdural hematomas in critical conditions.
abstract: Acute subdural hematoma (ASDH) patients presenting in a severe condition tend to have poor outcomes due to the significant brain edema required to maintain the ICP at less than 20-25 mmHg. This study compared the surgical outcomes of 16 critically ill patients with ASDH who underwent hematoma irrigation with trephination therapy (HITT) based on their initial ICP values. The initial mean GCS score upon admission was four. A unilateral dilated pupil was seen in one and bilateral dilated pupils were seen in seven patients. The co-existence of a brain contusion was seen in seven patients, brain swelling was noted in six patients, and both basal cistern effacement and a midline shift greater than 5 mm were observed in all patients. The mean initial ICP value was 45 mmHg (range: 3 to 85 mmHg). Ten patients (62.5%) underwent a rapid external decompression to evacuate the hematoma. By using the Glasgow Outcome Scale upon discharge a score of good recovery (GR) was assigned to two (12.5 %), moderate disability (MD) to four (25.0 %), vegetative state (VS) to two (12.5 %), and death (D) to eight (50.0 %) patients. All six patients who showed an initial ICP greater than 60 mmHg died despite intensive care. Eight patients who showed an initial ICP less than 40 mmHg had a favorable outcome, but two patients deteriorated due to a traumatic cerebrovascular disorder. It seems that the initial ICP monitoring with HITT for ASDH patients in critical condition may be an important factor for predicting both surgical outcome and clinical course.
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: D000328:Adult; D000368:Aged; D003422:Critical Care; D005260:Female; D023261:Glasgow Outcome Scale; D020199:Hematoma, Subdural, Acute / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014207:Trephining / Q000379:methods*; D055815:Young Adult