Retrospective analysis of operative treatment of a series of 100 patients with subdural hematoma.
This retrospective study of medical records, surgical protocols, patient observation cards, and imaging files of 100 patients treated for subdural hematoma analyzed the type of hematoma, patient age and sex, operative technique, neurological status, cause of injury, duration of hospital stay, mortality rate, and the number of and reasons for reoperations to determine the effects on treatment outcomes. The time between the head injury and onset of neurological symptoms was analyzed versus the type of hematoma determined from computed tomography (CT) scans. Acute hematomas accounted for 38% of the cases, with subacute hematomas representing 20%, and chronic ones accounting for 42%. In trauma patients, the mean time interval between the injury and onset of neurological symptoms was 0.38 days for acute hematomas, 13.8 days for subacute hematomas, and 23.75 days for chronic hematomas. Repeat surgery was carried out in 26% of the cases. Improvement was obtained in 44% of cases, deterioration in 20%, and no change in neurological status in 36%. Timing of the operations was between 15:00 and 23:00 in 45%, between 23:00 and 7:00 in 33%, and between 7:00 and 15:00 in 22%. The classification of hematomas based on CT presentation corresponds to the classification based on the time elapsed between injury and onset of symptoms, and appears to be appropriate and useful in everyday practice. No preceding injury was identified in 31.6% of acute hematomas, 50% of subacute hematomas, and 61.9% of chronic hematomas. Analysis of reoperations indicates that trepanation may be superior to craniotomy as primary surgery for subacute and chronic hematomas. Subdural hematoma surgeries take place at all times of the day, with most carried out outside the usual working hours.
Department of Neurosurgery and Peripheral Nerves Surgery, WAM University Hospital in Lodz, Medical University of Lodz, Lodz, Poland. bartoszgodlewski@wp.pl
Bartosz
B
Godlewski
Agnieszka
A
Pawelczyk
Tomasz
T
Pawelczyk
Katarzyna
K
Ceranowicz
Maciej
M
Wojdyn
Maciej
M
Radek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D020200:Hematoma, Subdural, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014207:Trephining