title: Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome.
abstract: OBJECTIVE
  Craniotomy (CO) and decompressive craniectomy (DC) are two main surgical options for acute subdural hematomas (ASDH). However, optimal selection of surgical modality is unclear and decision may vary with surgeon's experience. To clarify this point, we analyzed preoperative findings and surgical outcome of patients with ASDH treated with CO or DC.
  
  
  METHODS
  From January 2010 to December 2014, data for 46 patients with ASDH who underwent CO or DC were retrospectively reviewed. The demographic, clinical, imaging and clinical outcomes were analyzed and statistically compared.
  
  
  RESULTS
  Twenty (43%) patients underwent CO and 26 (57%) patients received DC. In DC group, preoperative Glascow Coma Scale was lower (p=0.034), and more patient had non-reactive pupil (p=0.004). Computed tomography findings of DC group showed more frequent subarachnoid hemorrhage (p=0.003). Six month modified Rankin Scale showed favorable outcome in 60% of CO group and 23% of DC group (p=0.004). DC was done in patient with more unfavorable preoperative features (p=0.017). Patients with few unfavorable preoperative features (<6) had good outcome with CO (p<0.001).
  
  
  CONCLUSIONS
  In selective cases of few unfavorable clinical findings, CO may also be an effective surgical option for ASDH. Although DC remains to be standard of surgical modality for patients with poor clinical status, CO can be an alternative considering the possible complications of DC.
authors.affiliation: Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.; Department of Neurosurgery, School of Medicine, Kangwon National University, Chuncheon, Korea.
authors.forename: Young Sub
authors.initials: YS
authors.lastname: Kwon
authors.affiliation: Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
authors.forename: Kook Hee
authors.initials: KH
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
authors.forename: Yun Ho
authors.initials: YH
authors.lastname: Lee
keywords: Craniotomy; Decompressive craniectomy; Hematoma, subdural, acute; Treatment outcome