Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma.
BACKGROUND
Decompressive craniectomy (DC) is helpful in lowering the intracranial pressure in patients with severe head injuries. However, it is still unclear which surgical approach (DC or craniotomy) is the optimal treatment strategy for severely head-injured patients with acute subdural hematoma (SDH). To clarify this point, we compared the outcomes and complications of the patients with acute SDH and low Glasgow Coma Scale (GCS) score treated with craniotomy or DC.


METHODS
We analyzed 102 patients with acute SDH and GCS scores of 4 to 8. Of them, 42 patients (41.2%) were treated with craniotomy and 60 (58.8%) treated with DC for evacuation of hematoma. The demographic and clinical data were analyzed including patient age, sex, injury mechanism, GCS score, pupil size and light reflex, time interval from injury to operation, types of surgical procedures, intracranial findings in pre- and postoperative computed tomography scan, intracranial pressure, complications, requirement of permanent cerebrospinal fluid diversion, and Glasgow Outcome Scale score after at least 1 year of follow-up.


RESULTS
The craniotomy and DC groups showed no difference in the demographic and clinical data. There was no difference in the outcomes and complication rates between these two groups except that the DC group had higher mortality than the craniotomy group (23.3% vs. 7.1%, p = 0.04).


CONCLUSIONS
Both craniotomy and DC were feasible treatment strategies for acute SDH. The patients with acute SDH and low GCS score treated with craniotomy or DC showed no difference in the outcomes and complications.
Department of Surgery, Chiayi Christian Hospital, Chiayi, Taiwan.
Shih-Han
SH
Chen
Yun
Y
Chen
Wen-Kuei
WK
Fang
Da-Wei
DW
Huang
Kuo-Chang
KC
Huang
Sheng-Hong
SH
Tseng
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods / Q000401:mortality; D056424:Decompressive Craniectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D020199:Hematoma, Subdural, Acute / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013624:Taiwan; D014057:Tomography, X-Ray Computed / Q000379:methods