title: Early Decompression of Acute Subdural Hematoma for Postoperative Neurological Improvement: A Single Center Retrospective Review of 10 Years.
abstract: OBJECTIVE
  This study was conducted to investigate survival related factors, as well as to evaluate the effects of early decompression on acute subdural hematoma (ASDH).
  
  
  METHODS
  We retrospectively reviewed cases of decompressive craniectomy (DC) for decade. In total, 198 cases of DC involved ASDH were available for review, and 65 cases were excluded due to missing data on onset time and a delayed operation after closed observation with medical care. Finally, 133 cases of DC with ASDH were included in this study, and various factors including the time interval between trauma onset and operation were evaluated.
  
  
  RESULTS
  In the present study, survival rate after DC in patients with ASDH was shown to be related to patient age (50 years old, p=0.012), brain compression ratio (p=0.042) and brain stem compression (p=0.020). Sex, preoperative mental status, and time interval between trauma onset and operation were not related with survival rate. Among those that survived (n=78), improvements in Glasgow Coma Scale (GCS) score of more than three points, compared to preoperative measurement, were more frequently observed among the early (less than 3 hours between trauma onset and operation) decompressed cases (p=0.013). However, improvements of more than 4 or 5 points on the GCS were not affected by early decompression.
  
  
  CONCLUSIONS
  Early decompression of ASDH was not correlated with survival rate, but was related with neurological improvement (more than three points on the GCS). Accordingly, early decompression in ASDH, if indicated, may be of particular benefit.
authors.affiliation: Department of Neurosurgery, Guro Teun Teun Research Institute, Seoul, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Yu Shik
authors.initials: YS
authors.lastname: Shim
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Dongkeun
authors.initials: D
authors.lastname: Hyun
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Hyeonseon
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Kim
keywords: Acute subdural hematoma; Decompression; Early operation; Neurological improvement; Survival rate