The Surgical Outcome of Traumatic Extraaxial Hematomas Causing Brain Herniation

Objective & Hypothesis:AIm: The aim of this study was to assess the surgical outcome and the prognostic importance of clinical and radiological data of patients operated emergently for an extraaxial hematoma causing brain herniation. mATERIAl and mEThODS: This retrospective study comprised 108 adult patients who were operated due to herniated traumatic extraaxial hematomas from January 2000 to January 2013.

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Key Findings & Data:RESUlTS: Of 108 patients, 63 patients (58.3%) were diagnosed as subdural hematoma (SDH), and 45 patients (41.7%) as epidural hematoma (EDH).

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Conclusion & Impact:We recommended postoperative ICP monitoring for all patients presenting with the brain herniation due to traumatic extraaxial hematoma.

🔬Design:Research Article

📍Scope:2000 Verileri

⚙️Variables:Domain Parameters

Özet

AIm: The aim of this study was to assess the surgical outcome and the prognostic importance of clinical and radiological data of patients operated emergently for an extraaxial hematoma causing brain herniation. mATERIAl and mEThODS: This retrospective study comprised 108 adult patients who were operated due to herniated traumatic extraaxial hematomas from January 2000 to January 2013. RESUlTS: Of 108 patients, 63 patients (58.3%) were diagnosed as subdural hematoma (SDH), and 45 patients (41.7%) as epidural hematoma (EDH). An unfavorable outcome was significantly increased for patients who were diagnosed as SDH (90.4%) compared with EDH patients (33.3%). Mortality rate for herniated SDH patients was 65.1%, and 26.6% for herniated EDH patients. High mortality and unfavorable outcome ratios were associated with Glasgow Coma Scale scores at admission, mean postoperative intracranial pressure (ICP) values, type of the brain herniation, interval from the time of trauma to the time of hematoma decompression, the duration of the brain herniation, intraoperative acute brain swelling, hematoma volume and thickness, degree of the midline shift and the obliteration of the basal cisterns. CONClUSION: Our data showed that, postoperative ICP values were one most important predictor of the mortality. We recommended postoperative ICP monitoring for all patients presenting with the brain herniation due to traumatic extraaxial hematoma.

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Cite This Article

GÜRER, B., KERTMEN, H., YILMAZ, E. R., DOLGUN, H., HASTÜRK, A. E., ŞEKERCİ, Z. (2017). The Surgical Outcome of Traumatic Extraaxial Hematomas Causing Brain Herniation. Turkish Neurosurgery, Cilt: 27 - Sayı: 1, 37–52. https://ajindex.com/articles/404604

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References (1)

American Association for the Surgery of Trauma; Child Neurology Society; International Society for Pediatric Neurosurgery; International Trauma Anesthesia and Critical Care Society; Society of Critical Care Medicine; World Federation of Pediatric Intensive and Critical Care Societies; National Center for Medical Rehabilitation Research; National Institute of Child Health and Human Development; National Institute of Neurological Disorders and Stroke; Synthes USA; International Brain Injury Association: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. J Trauma 54: S235-310, 2003 2. Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491- 502, 1977 3. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW: Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 24: S37-44, 2007 4. Bricolo AP, Pasut LM: Extradural hematoma: Toward zero mortality. A prospective study. Neurosurgery 14: 8-12, 1984 5. 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 58: S7-15, 2006 6. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE: Surgical management of acute subdural hematomas. Neurosurgery 58: S16-24, 2006 7. Chen SH, Chen Y, Fang WK, Huang DW, Huang KC, Tseng SH: Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma 71: 1632-1636, 2011 8. Cohen JE, Montero A, Israel ZH: Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients. J Trauma 41: 120-122, 1996 9. Cordobés F, Lobato RD, Rivas JJ, Muñoz MJ, Chillón D, Portillo JM, Lamas E: Observations on 82 patients with extradural hematoma. Comparison of results before and after the advent of computerized tomography. J Neurosurg 54: 179-186, 1981 10. D'Amato L, Piazza O, Alliata L, Sab