title: Surgery for bilateral large intracranial traumatic hematomas: evacuation in a single session.
abstract: OBJECTIVE
  Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia.
  
  
  METHODS
  In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated.
  
  
  RESULTS
  The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived.
  
  
  CONCLUSIONS
  Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.
authors.affiliation: Department of Neurosurgery, Siem Reap Provincial Hospital, Siem Reap, Cambodia.
authors.forename: Heng
authors.initials: H
authors.lastname: Kompheak
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
authors.forename: Sun-Chul
authors.initials: SC
authors.lastname: Hwang
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
authors.forename: Dong-Sung
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
authors.forename: Dong-Sung
authors.initials: DS
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
authors.forename: Bum-Tae
authors.initials: BT
authors.lastname: Kim
keywords: Craniotomy; Epidural hematoma; Intracranial hemorrhages; Multiple lesions