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Surgical Management of Trauma-Related Intracranial Hemorrhage-a Review. Curr Neurol Neurosci Rep 2020; 20:63. [PMID: 33136200 DOI: 10.1007/s11910-020-01080-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The surgical management of trauma-related intracranial hemorrhage is characterized by marked heterogeneity. Large prospective randomized trials have generally been prohibited by the ubiquity of concordant pathology, diversity of trauma systems, and paucity of clinical equipoise among providers. RECENT FINDINGS To date, the results of retrospective studies and surgeon preference have driven the indications, modality, extent, and timing of surgical intervention in the global neurosurgical community. With advances in our understanding of the pathophysiology of hemorrhagic TBI and the advent of novel surgical techniques, a reevaluation of surgical indication, timing, and approach is warranted. In this way, we can work to optimize surgical outcomes, achieving maximal functional recovery while minimizing surgical morbidity.
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Singh R, Sahu A, Singh K, Prasad RS, Pandey N. Clinical, operative, and outcome analysis of giant extradural hematoma: A retrospective study in tertiary care center. Surg Neurol Int 2020; 11:236. [PMID: 32874739 PMCID: PMC7451170 DOI: 10.25259/sni_128_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/23/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This study is aimed to find a critical volume of operated giant or massive extradural hematoma (EDH) that affects outcome significantly and analyze them with respect to their clinical, surgical, and outcome perspective. METHODS This retrospective study includes 253 patients operated for EDH in emergency in the Department of Neurosurgery of IMS BHU, Varanasi, India, a tertiary care center, between August 1, 2018, and November 1, 2019. Giant EDH critical volume was evaluated. Twenty-nine patients with giant EDH with clot volume ≥ 80 ml were further analyzed for clinical, surgical, and outcome predictive factors. Statistical analysis was done using Prism GraphPad ver. 8.0.0. P value was taken at 0.05. RESULTS Dichotomized group analysis with Glasgow Outcome Score (GOS) 4-5 versus GOS 1-3 for testing clot volume revealed significance difference with P < 0.001. Mean volume of GOS 1-3 came out to be 79.68 ml. Hence, we took clot volume >80 ml for further analysis. The most common age group was 20-40 (55.17%). M2 (31.03%) was the most common best motor response in operated giant EDH cases. Most of them were having severe (79.31%) head injury. Glasgow Coma Scale (GCS) at admission (P < 0.0001), pupillary changes (P = 0.0032), and best motor response (P < 0.0001) was significantly (P < 0.05) associated with outcome following surgery for giant EDH. CONCLUSION Giant EDH with volume ≥ 80 ml is associated with poorer outcome. GCS at admission, pupillary changes, and best motor response is predictors for surgical outcome of giant EDH.
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Affiliation(s)
| | - Anurag Sahu
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh, India
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Early Surgery in Trauma Patients Is a Key Performance Indicator of Outcome—A Case Series Analysis. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02371-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rosyidi RM, Priyanto B, Al Fauzi A, Sutiono AB. Toward zero mortality in acute epidural hematoma: A review in 268 cases problems and challenges in the developing country. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2019.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Khaled CN, Raihan MZ, Chowdhury FH, Ashadullah ATM, Sarkar MH, Hossain SS. Surgical management of traumatic extradural haematoma: Experiences with 610 patients and prospective analysis. INDIAN JOURNAL OF NEUROTRAUMA 2017. [DOI: 10.1016/s0973-0508(08)80004-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractThis study was carried out to find out the age, sex, mode of injury, localization, clinical presentation, CT findings, operative measures and outcome of extradural haematoma in the patient population at Dhaka Medical College. 610 consecutive patients with cranial extradural haematoma who underwent surgery in department of Neurosurgery from 1st January 2006 to 6th October 2008 were included in this prospective study. Each of the patients were evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome. Out of 610 cases 86.32 % were male and 13.78 % were female. The male and female ratio was 6.27: 1. Age ranged from 2.5 to 83 years. Commonest age group was 21 to 30 years. Commonest mode of injury was Road traffic Accident 53.45%, followed by Assaults. Most common clinical presentation was headache / Vomiting 63.61 %, followed by altered sensorium 60.66 %. In this present prospective study of 610 cases of EDH, temporo parietal site was involved in 33.45 % followed by frontal region in 23.28 %. Sixty five patients (10.66 %) died; 19 of these had associated brain injuries and 28 cases were deeply unconscious. Extradural haematoma is a neurosurgical emergency where early surgical intervention is associated with the best prognosis. Many factors affects the outcome of extradural haematoma surgery and the most important one is the duration of time between incident/accident and operation in neurosurgical operation theater; mortality can be close to 0% if this time interval can be minimized.
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Potapov AA, Krylov VV, Gavrilov AG, Kravchuk AD, Likhterman LB, Petrikov SS, Talypov AE, Zakharova NE, Solodov AA. [Guidelines for the management of severe traumatic brain injury. Part 3. Surgical management of severe traumatic brain injury (Options)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:93-101. [PMID: 27070263 DOI: 10.17116/neiro201680293-101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traumatic brain injury (TBI) is one of the main causes of mortality and severe disability in young and middle age patients. Patients with severe TBI, who are in coma, are of particular concern. Adequate diagnosis of primary brain injuries and timely prevention and treatment of secondary injury mechanisms markedly affect the possibility of reducing mortality and severe disability. The present guidelines are based on the authors' experience in developing international and national recommendations for the diagnosis and treatment of mild TBI, penetrating gunshot wounds of the skull and brain, severe TBI, and severe consequences of brain injury, including a vegetative state. In addition, we used the materials of international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe TBI, which were published in recent years. The proposed recommendations for surgical treatment of severe TBI in adults are addressed primarily to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in treating these patients.
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Affiliation(s)
- A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - V V Krylov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A D Kravchuk
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - S S Petrikov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - A E Talypov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | | | - A A Solodov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
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Nelson KS, Brearley AM, Haines SJ. Evidence-based assessment of well-established interventions: the parachute and the epidural hematoma. Neurosurgery 2015; 75:552-9; discussion 559. [PMID: 25050576 DOI: 10.1227/neu.0000000000000504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The methods of evidence-based medicine are a relatively recent development in the understanding of clinical practice. They are criticized as not providing support for interventions long held to be highly effective based on experience that predated the availability of evidence-based analysis. OBJECTIVE To determine if the methods of evidence-based medicine can be successfully applied to interventions established before those methods were developed. METHODS Systematic review of English language literature on the natural history and treated prognosis of acute epidural hematoma and analysis of existing data on mortality associated with parachute use. DATA SOURCES Sources of data included Medline, Old Medline, Science Citation Index, British and US Parachute Associations, and Federal Aviation Administration and National Transportation Safety Board databases (both of the United States). Also included were national databases reporting mortality and total number of parachute uses. RESULTS The estimated mortality of falling from an airplane with an ineffective parachute is 74% (69-79). Mortality associated with effective parachute deployment is between 0.0011% and 0.0017%. For acute epidural hematoma, estimated mortality is 98.54% (95.1-99.9) without treatment and 12.9% (10.5-15.3) with treatment. The number needed to treat to prevent 1 death for the parachute is estimated to be 1.35 (1.27-1.45) and for epidural hematoma 1.17 (1.13-1.22) (95% binomial confidence intervals in parentheses). CONCLUSION The methods of evidence-based medicine are robust and can deal with interventions of great face validity and those considered well established before such methods were well developed. We propose initial criteria for evaluating the quality of evidence supporting long-established interventions.
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Affiliation(s)
- Kyle S Nelson
- *Department of Neurosurgery, University of Nebraska Medical Center, Section of Neurosurgery, Omaha, Nebraska; ‡Biostatistical Design and Analysis Center (BDAC), Clinical and Translational Science Institute (CTSI), School of Public Health, University of Minnesota Academic Health Center, Minneapolis, Minnesota; and §Department of Neurosurgery, University of Minnesota School of Medicine, Minneapolis, Minnesota
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Abstract
OBJECTIVE This study was undertaken to assess the clinical and radiological characteristics of children with traumatic extradural hematoma (TEDH), and factors affecting the initial neurological status and outcome. METHODS Medical records of 269 consecutive children with TEDH from 2005 to 2012 were retrospectively reviewed, factors affecting the initial neurological status and outcomes were explored using univariate and multivariate analysis. RESULTS There were 166 boys and 103 girls (average age: 7.0 years). Fall from a height (59 %) was the most common mechanism of head injury. With increasing age, an increase of motor-vehicle accident and assault was noted. Among the children 85.5 % experienced a Glasgow Coma Scale (GCS) of 13-15, 9.7 % with GCS 9-12, and 4.8 % with GCS 3-8. The main clinical manifestations were headache, vomiting and nausea, and conscious disturbance. The main locations were the temporal, temporoparietal, and frontal regions. The 97.4 % saw a favorable outcome, whereas 2.6 % had a poor outcome (overall mortality: 1.1 %). CONCLUSION Many factors influenced the prognosis; the most important factors affecting prognosis were the initial neurological condition and secondary brain edema, while the initial neurological status were associated with pupillary abnormality, clinical progression, the number and volume of TEDH, and midline shift. Although the outcome was excellent in most cases, early diagnosis and surgical evacuation before irreversible brain damage was important to lower mortality for those massive TEDHs.
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Balik V, Lehto H, Hoza D, Phornsuwannapha S, Toninelli S, Romani R, Sulla I, Hernesniemi J. Post-Traumatic Frontal and Parieto-Occipital Extradural Haematomas: a Retrospective Analysis of 41 Patients and Review of the Literature. ACTA ACUST UNITED AC 2011; 72:169-75. [DOI: 10.1055/s-0031-1286261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractThe purpose of this study was to analyse the differences between patients with frontal (FEDH) or parieto-occipital (POEDH) epidural haematomas and evaluate possible statistically significant prognostic factors.In this retrospective study of a group of 41 patients with a FEDH (17) or POEDH (24 individuals), the authors analysed the influence of gender, age, type of injury, clinical presentation, Glasgow coma scale (GCS) score on admission, radiological findings, and time interval from trauma to surgery on outcomes. A good recovery and moderate disability were considered a “good” or “favourable outcome”, whereas severe disability, a vegetative state or death was a “poor outcome”.In the POEDH subgroup, a higher GCS score on admission and a younger age were statistically significant prognostic factors for a better outcome (p=0.006, rs=0.702). In the subgroup of patients with FEDHs, the results were not significant. However, patients with FEDHs more frequently had “good outcomes” than members of the POEDH subgroup (88.2 vs. 70.9%). Children (≤ 18 years old) constituted a smaller portion of the POEDH subgroup (12.5%) than those in the FEDH subgroup (41.2%). The evaluation of time intervals between the accident and surgery (≤ 24 h vs. > 24 h) showed no significant influence on outcomes in any of the studied subgroups. However, patients undergoing surgery within 24 h of their injury had a less favourable GCS score on admission than those operated on more than 24 h after their injury. Subacute and chronic clinical courses predominated in patients with a FEDH (10/17 FEDH vs. 11/22 POEDH). Different accompanying intradural lesions occurred in 12 patients of the POEDH subgroup, but only in 2 of the FEDH subgroup (50 vs. 11.8%). However, the presence of such lesions did not significantly deteriorate surgical outcomes in either of the subgroups.
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Turtz AR, Goldman HW. Head Injury. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE. Surgical Management of Acute Epidural Hematomas. Neurosurgery 2006. [DOI: 10.1227/01.neu.0000210363.91172.a8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
RECOMMENDATIONS (see Methodology)
Indications for Surgery
Timing
Methods
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Affiliation(s)
- M Ross Bullock
- Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Randall Chesnut
- Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington
| | - Jamshid Ghajar
- Department of Neurological Surgery, Weil Cornell Medical College of Cornell University, New York, New York
| | - David Gordon
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York
| | - Roger Hartl
- Department of Neurological Surgery, Weil Cornell Medical College of Cornell University, New York, New York
| | - David W. Newell
- Department of Neurological Surgery, Swedish Medical Center, Seattle, Washington
| | - Franco Servadei
- Department of Neurological Surgery, M. Bufalini Hospital, Cesena, Italy
| | - Beverly C. Walters
- Department of Neurological Surgery, New York University School of Medicine, New York, New York
| | - Jack E. Wilberger
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
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