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2016 ; 12
(1
): 22-7
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gab.com Text
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Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical
Selection and Clinical Outcome
#MMPMID27182498
Kwon YS
; Yang KH
; Lee YH
Korean J Neurotrauma
2016[Apr]; 12
(1
): 22-7
PMID27182498
show ga
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). CONCLUSION: 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.