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Crinnion W, Doke T, Yordanov S, Moffat D, O'Halloran PJ, Mckenna G, Offiah C, Uff C. Radiological prediction of contralateral extradural haematoma following evacuation of traumatic acute subdural haematoma. Br J Neurosurg 2024; 38:367-371. [PMID: 33570450 DOI: 10.1080/02688697.2021.1877612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To identify radiological predictors of contralateral extradural haematoma (CEDH) in patients undergoing evacuation of acute subdural haematoma (ASDH). DESIGN Retrospective case-control study. SUBJECTS Patients requiring evacuation of traumatic ASDH via craniotomy/craniectomy with contralateral skull fracture were analysed in two groups: those who developed CEDH postoperatively and those who did not. MATERIALS AND METHODS Retrospective analysis of severe traumatic brain injury admissions over 24 months (2017-2019) at a major trauma centre. Pre- and post-operative CT scans were reviewed by a Consultant Neuroradiologist for initial fracture haematoma (FH) and specific contralateral skull fracture features (CLFF) comprising: complex petrous fracture, suture diastasis and fractures involving foramen spinosum or middle meningeal groove (MMG). RESULTS 35 patients had ASDH evacuation (age: 11-74); 7 with craniotomy, 28 with craniectomy. 9/35 developed CEDH of whom 7 underwent bilateral craniotomy/craniectomy. 8/9 with CEDH had FH, 6/26 of those without CEDH had FH. All patients with CEDH had CLFF. 6/9 had >1 CLFF. CLFF was identified in 9/26 patients without CEDH and only 3/26 non-CEDH had >1 CLFF. Analysis using univariate logistic regression identified statistically significant factors for the development of CEDH which were: younger age, FH on initial CT, increasing number of CLFF and MMG involvement alone. After multivariate analysis, only younger age and FH were significant. CONCLUSIONS FH and CLFF on CT enable prediction of CEDH in patients undergoing evacuation of traumatic ASDH. These features raise a high index of suspicion for this complication and may expedite investigation and management for CEDH.
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MESH Headings
- Humans
- Child
- Adolescent
- Young Adult
- Adult
- Middle Aged
- Aged
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Retrospective Studies
- Case-Control Studies
- Craniotomy/adverse effects
- Hematoma, Subdural/surgery
- Skull Fractures/complications
- Skull Fractures/diagnostic imaging
- Skull Fractures/surgery
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Subdural, Intracranial/surgery
- Treatment Outcome
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Affiliation(s)
- William Crinnion
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Thomas Doke
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Stefan Yordanov
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Daniel Moffat
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | | | - Grainne Mckenna
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Curtis Offiah
- Department of Neuroradiology, The Royal London Hospital, London, UK
| | - Chris Uff
- Department of Neurosurgery, The Royal London Hospital, London, UK
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Jung IH, Yun JH, Lee SK. Risk Factors for Postoperative Contralateral Hemorrhage in Patients With Traumatic Brain Injury who Underwent Surgical Treatment: A Multicenter Study. Korean J Neurotrauma 2023; 19:42-52. [PMID: 37051031 PMCID: PMC10083440 DOI: 10.13004/kjnt.2023.19.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 02/25/2023] Open
Abstract
Objective Patients with a contralateral intracranial hemorrhage after decompressive craniectomy have a worse prognosis than those whose recovery is uneventful. Therefore, the objective of this study was to identify risk factors for postoperative contralateral hemorrhage (PCH) in patients who underwent unilateral craniectomy or craniotomy due to a traumatic brain injury (TBI). Methods Data were obtained from the Korean Neuro-Trauma Data Bank System and retrospectively reviewed. Patients who had a unilateral craniectomy or craniotomy for acute TBI were included in this study. Clinical outcomes of a PCH group and an uneventful group were compared and the risk factors for PCH were identified using regression analysis. Results A total of 326 patients were included in this study. PCH was observed in 25 (7.7%) patients. The Glasgow coma scale (GCS) and Glasgow outcome scale extended (GOSE) scores at discharge were significantly lower in the PCH group than those in the uneventful group (GCS: 3.6 vs. 6.2, p=0.043; GOSE: 2.1 vs. 3.2, p=0.032). In the multivariable regression analysis, when the time from injury to surgery was shorter than 150 minutes, the risk of PCH was increased by 4.481 times (p=0.005). When the intraoperative transfusion volume was more than 1.5 L, the risk of PCH was increased by 4.843 times (p=0.003). Conclusion The risk of PCH is increased when the time from injury to surgery is shorter than 150 minutes and when the intraoperative transfusion volume is greater than 1.5 L. Neurosurgeons must predict and be prepared for the development of PCH in high-risk patients.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
- Korea Neuro-Trauma Data Bank Committee, Korean Neurotraumatology Society, Seoul, Korea
| | - Jung-Ho Yun
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Sang Koo Lee
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - KNTDB Investigators
- Korea Neuro-Trauma Data Bank Committee, Korean Neurotraumatology Society, Seoul, Korea
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3
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Singh A, Wadhwa C, Karthigeyan M, Salunke P, Bansal H, Chaudhary AK. Spectrum of remote site extradural hematomas following decompressive craniectomy: Does fracture always co-exist? Surg Neurol Int 2021; 12:443. [PMID: 34621559 PMCID: PMC8492426 DOI: 10.25259/sni_484_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background Remote-site extradural hematomas (EDHs) after decompressive-surgeries for traumatic brain injury (TBI) are rarely encountered. Typically, they form contralateral to the injured side, with an overlying fracture. We present a subset which developed EDH immediately after decompressive-hemi-craniectomy for TBI, most without an evidence of fracture, and not limited to contralateral location. Methods Nine such patients were retrospectively identified. Plausible mechanisms, management issues and outcomes have been discussed. Results All nine patients were victims of severe-TBI. Six did not have any skull-fractures. Eight showed hemispheric-injuries while one had bifrontal-contusions. In hemispheric-injuries, midline-shift was at least 8 mm except one with midline-shift of 6 mm. The EDH was straddling the midline in 2 (bifrontal-1, bi-occipital-1), and juxtaposed to the previous craniectomy in 1, apart from a contralateral-bleed in 6; all, except one, needed evacuation. In most patients, venous-source of bleed was identified. All had improved from their preoperative Glasgow coma scale (GCS) at follow-up. Conclusion A fracture need not always co-exist in EDH following decompressive craniectomy. However, an extra-caution is suggested in its presence. Given the need for surgical-evacuation in most patients and an inability to assess immediate postoperative-GCS in severely head-injured, a routine postoperative-computed tomography is recommended to avoid overlooking such potentially treatable condition.
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Affiliation(s)
- Apinderpreet Singh
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chetan Wadhwa
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hanish Bansal
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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4
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Pillai MK, Kariyattil R, Govindaraju V, Kochummen K, Kumar R. Extradural Hematoma Following Decompressive Craniectomy for Acute Subdural Hematoma: Two Case Reports Illustrating Different Mechanisms. Asian J Neurosurg 2018; 13:1213-1215. [PMID: 30459897 PMCID: PMC6208202 DOI: 10.4103/ajns.ajns_87_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The occurrence of extradural hematoma (EDH) after decompressive craniectomy (DC) for traumatic brain injury is uncommon. We report two cases, one developing ipsilateral EDH and another developing contralateral simultaneous EDH and subdural hematoma after DC. The strategies to anticipate the occurrence of such concurrent hematomas (CH) are highlighted. We propose a subclassification of CH into “immediate” and “delayed,” based on their difference in clinical presentation, image findings, pathogenesis, and surgical management.
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Affiliation(s)
- Mahesh Krishna Pillai
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Rajeev Kariyattil
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Venkatesh Govindaraju
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Koshy Kochummen
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Rajinder Kumar
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
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Wu R, Shi J, Cao J, Mao Y, Dong B. Two occurrences of delayed epidural hematoma in different areas following decompressive craniectomy for acute subdural hematoma in a single patient: a case report. BMC Surg 2017; 17:123. [PMID: 29202748 PMCID: PMC5715532 DOI: 10.1186/s12893-017-0303-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/09/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Delayed epidural hematoma (DEH) following evacuation of traumatic acute subdural hematoma (ASDH) or acute epidural hematoma (EDH) is a rare but devastating complication, especially when it occurs sequentially in a single patient. CASE PRESENTATION A 19-year-old man who developed contralateral DEH following craniotomy for evacuation of a traumatic right-side ASDH and then developed a left-side DEH of the posterior cranial fossa after craniotomy for evacuation of the contralateral DEH. He was immediately returned to the operating room for additional surgeries and his neurological outcome was satisfactory. CONCLUSIONS Although DEH occurring after evacuation of ASDH or acute EDH is a rare event, timely recognition is critical to prognosis.
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Affiliation(s)
- Ruhong Wu
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Jia Shi
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Jiachao Cao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Yumin Mao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Bo Dong
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
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Kim PS, Yu SH, Lee JH, Choi HJ, Kim BC. Intraoperative Transcranial Sonography for Detection of Contralateral Hematoma Volume Change in Patients with Traumatic Brain Injury. Korean J Neurotrauma 2017; 13:137-140. [PMID: 29201848 PMCID: PMC5702749 DOI: 10.13004/kjnt.2017.13.2.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/28/2017] [Accepted: 09/15/2017] [Indexed: 11/15/2022] Open
Abstract
The authors present two clinical cases, in which intraoperative transcranial sonography (TCS) was used to detect a change in contralateral hematoma volume. A 51-year-old female and a 5-year-old male underwent osteoplastic craniotomy for epidural hematoma removal. Scant contralateral hematoma was evident by preoperative computed tomography in both patients. Intraoperative TCS was used to detect changes in contralateral hematomas. After observing a volume change in one case, a second operation was performed immediately. Based in this experience, the authors recommend intraoperative TCS for the detection of contralateral hematoma volume changes.
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Affiliation(s)
- Pil Soo Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Han Yu
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jung Hwan Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byung Chul Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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7
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Oh MJ, Jeong JH, Shin DS, Hwang SC, Im SB, Kim BT, Shin WH. Postoperative Contralateral Hematoma in Patient with Acute Traumatic Brain Injury. Korean J Neurotrauma 2017; 13:24-28. [PMID: 28512614 PMCID: PMC5432445 DOI: 10.13004/kjnt.2017.13.1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/11/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Head injury is a leading cause of death and disability in subjects who suffer a traumatic accident. Contralateral hematomas after surgery for traumatic brain injury are rare. However, an unrecognized, these hematomas can cause devastating results. We presented our experience of these patients and discussed diagnosis and management. Methods This study included 12 traumatic patients with acute traumatic brain injury who developed delayed contralateral hematoma after evacuation of an acute hematoma. Clinical and radiographic data was obtained through review of medical records and radiographs retrospectively. Results Ten males and two females were included in the study. Ten (83.3%) patients had severe head injury (Glasgow Coma Scale [GCS] score <8). Intraoperative brain swelling during removal of the traumatic subdural hematoma was noted in 10 (83.3%) patients. A skull fracture on the side contralateral to the acute hematoma was noted on computed tomography (CT) scans of nine (75%) patients. Three (33.3%) patients with severe head injury (GCS <8) died. Only (10%) one patient with a severe head injury had less severe disability. Conclusion A postoperative CT scan is essential in patients with acute traumatic brain injury and a contralateral skull fracture or a low GCS score. Our results indicated that it is very important to evaluate this rare but potentially devastating complication.
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Affiliation(s)
- Myeong-Jin Oh
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Dong-Seong Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soo Bin Im
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Won-Han Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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8
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Gong J, Li Q, Cao Y, Zheng X, Ma Y, Zhan R. Serial Attacks: Contralateral Hematoma Secondary to Decompressive Craniectomy for Traumatic Brain Injury Led to Posttraumatic Cerebral Infarction. J Craniofac Surg 2016; 27:e159-62. [PMID: 26854773 DOI: 10.1097/scs.0000000000002404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 40-year-old man suffered severe brain injury and received left side subdural hematoma evacuation with decompressive craniectomy. Intraoperative brain swelling had occurred during the surgery. Postoperative computed tomography (CT) scan was done immediately and showed a contralateral epidural hematoma resulting in herniation. Secondary hematoma evacuation was performed and found a linear fracture near a bleeding meningeal artery. 2 days later CT scan showed cerebral infarction mainly in right posterior cerebral artery distribution. Early diagnosis by postoperative CT scan or other potential ways such as intraoperative sonography is important to prompt treatments and interrupt the pathophysiological chain of the serial attacks.
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Affiliation(s)
- JiangBiao Gong
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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9
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Meguins LC, Sampaio GB, Abib EC, Adry RARDC, Ellakkis RFEH, Ribeiro FWJ, Maset ÂL, de Morais DF. Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): a case report. J Med Case Rep 2014; 8:153. [PMID: 24886310 PMCID: PMC4066315 DOI: 10.1186/1752-1947-8-153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/11/2014] [Indexed: 10/24/2023] Open
Abstract
Introduction Decompressive surgery for acute subdural hematoma leading to contralateral extradural hematoma is an uncommon event with only few cases previously reported in the English medical literature. Case presentation The present study describes the case of a 39-year-old White Brazilian man who had a motorcycle accident; he underwent decompressive craniectomy for the treatment of acute subdural hematoma and evolved contralateral extradural hematoma following surgery. Conclusion The present case highlights the importance of close monitoring of the intracranial pressure of severe traumatic brain injury, even after decompressive procedures, because of the possible development of contralateral extradural hematoma.
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Affiliation(s)
- Lucas Crociati Meguins
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Residente do Serviço de Neurocirurgia, Hospital de Base, São Paulo, Brazil.
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Solomiichuk VO, Drizhdov KI. Contralateral delayed epidural hematoma following intracerebral hematoma surgery. Surg Neurol Int 2013; 4:134. [PMID: 24233058 PMCID: PMC3815043 DOI: 10.4103/2152-7806.119234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/29/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Delayed epidural hematoma (EDH) is an uncommon finding in patients after intracranial hematomas evacuation. It occurs in 6.7-7.4% of cases. A total of 29 reports were found in literature. Between them were no cases of delayed contralateral EDH after intracerebral hematoma evacuation. CASE DESCRIPTION This paper represents a clinical case of a 28-year-old male patient with opened penetrating head injury, who underwent left frontal lobe intracerebral hematoma evacuation and one day later a contralateral EDH was found and successfully surgically treated. CONCLUSION Contralateral EDH is a life-threatening neurosurgical emergency case, which can occur during first 24 hours after decompressive craniectomy. Control CT scans must be performed next day after the operation to verify and treat contralateral EDH timely.
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Wen L, Li QC, Wang SC, Lin Y, Li G, Gong JB, Wang F, Su L, Zhan RY, Yang XF. Contralateral haematoma secondary to decompressive craniectomy performed for severe head trauma: A descriptive study of 15 cases. Brain Inj 2013; 27:286-92. [DOI: 10.3109/02699052.2012.743180] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shen J, Pan JW, Fan ZX, Zhou YQ, Chen Z, Zhan RY. Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review. Acta Neurochir (Wien) 2013; 155:335-41. [PMID: 23238942 DOI: 10.1007/s00701-012-1569-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The occurrence of a contralateral acute epidural hematoma (AEDH) following removal of an acute subdural hematoma (ASDH) is a rare but nearly devastating postoperative complication. Here, we describe a series of five patients with contralateral AEDH and provide a review of the literature to elucidate the characteristics and improve management of these patients. METHODS A total of 386 patients underwent ASDH evacuations in our hospital between August 2008 and July 2011. Five of these patients (1.3 %) developed AEDH that required surgery. Thirty-two additional patients were identified by a search of the PubMed database. Clinical features, surgical treatment, and outcomes (scored by Glasgow outcome scale, GOS) of the collective 37 AEDH cases were analyzed retrospectively. RESULTS Contralateral AEDH after ASDH evacuation occurred in 27 males (73 %) and 10 females (27 %) (mean age: 35.9 ± 14.2 years). Twenty-six patients (70 %) had unfavorable outcomes (GOS 1-3), and 11 patients (30 %) had favorable outcomes (GOS 4-5). Contralateral skull fractures and intraoperative acute brain swelling occurred in 30 (81 %) and 28 (76 %) patients, respectively. The preoperative Glasgow coma score (GCS) was significantly associated with outcome (p < 0.05). CONCLUSIONS Lower preoperative GCS score is an independent risk factor for prognosis of contralateral AEDH after ASDH. Postoperative management should include assessment of AEDH in patients treated for contralateral skull fractures and who experienced intraoperative acute brain swelling. We recommend early decompression with a burr-hole craniotomy, immediately followed by a decompressive craniectomy. This strategy provides gradual decompression, while advancing the initial surgical time and preventing the suddle decreased tamponade effect. As such, it may help decrease the risk of contralateral AEDH associated with decompression.
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