Mortality in Patients Operated for Traumatic Acute Sub-Dural Hemorrhage (ASDH), A Surgical Case Series
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- Category: Vol. 85, September 2017
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Mortality in Patients Operated for Traumatic Acute Sub-Dural Hemorrhage (ASDH), A Surgical Case Series, WALID E. EL-HALABY
Abstract
Background: Decompressive craniectomy was first de-scribed by Kocher in 1901 reporting the use of large craniec-tomy in the management of refractory posttraumatic cerebral edema, Aim of management is to prevent intracranial hyper-tension as well as to maintain the cerebral perfusion pressure. In this study, we are addressing patients undergoing surgical intervention in the form of decompressive craniectomy or craniotomy.
Objective: To estimate the predicting factors that favor the outcome.
Patients and Methods: A prospective study was conducted on 33 patients Noncontract CT brain was done, all patients having unilateral ASDH with midline shift more than 5mm were operated upon regardless of their conscious level. Patients with bilateral dilated fixed pupils or lost brain stem reflexes as well as patients with GCS higher than 10 were excluded. Patients with subdural hematoma resulting from penetrating trauma e.g. gunshots as well as ASDH resulting from cere-brovascular insult e.g. ruptured AVM were excluded.
Results: 20 patients (60%) died, 3 patients (9%) didn’t reach full recovery (vegetative), 10 patients (30%) recovered completely reaching GCS 15. All patients with GCS 3&4 died.
Conclusion: Decompressive craniectomy or craniotomy is quite beneficial and effective method to control the raised ICP. It helps also to reduce the midline shift and subfalcine herniation. Early surgery reduces the time during which the brain is subjected to high intracranial pressure thus improves the outcome. We don’t recommend any intervention to patients with initial GCS 3 and 4 as all of them died.