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Role of Decompressive Craniectomy in Acute Subdural Haematoma

Jay Prakash , I.D. Chaurasia1 , Jay Prakash Singour2 , Agam Sharma3 , Mahim Kosariya4 , Anil Kumar Gupta5

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International Journal of Neurology and Neurosurgery 11(2):p 109-113, April-June 2019. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.11219.1

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I.D. Chaurasia, Jay Prakash Singour, Agam Sharma et al. Role of Decompressive Craniectomy in Acute Subdural Haematoma. Int J Neurol Neurosurg. 2019;11(2):109-113.

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Abstract

Background: Our aim in the present study was to assess the value of Decompressive Craniectony in acute SDH. We sought to assess whether the surgical procedure conferred any increase in short-term survival rates. We included all patients who underwent an operation in our unit for evacuation of an AcSDH sustained as a result of trauma, It is still not clear whether early decompression can improve the outcome in severe head injury (GCS 8 or <8). Aim & Objectives: The study was conducted to assess the value of decompressive craniectomy in acute SDH and to evaluate the outcome / prognostic factors and complications of decompressive craniectomy. Methods: From July 2016 to April 2018, 138 patients with Acute SDH due to trauma under went for Decompressive Craniectomy. The clinical status (GCS), imaging C.T. Scan/ MRI and outcome were analyzed at Neurosurgery unit of Surgery Dept. of Hamidia Hospital which is affiliated with Gandhi Medical College, Bhopal (India). Qui square independent test and Fishers test were used to evaluate the prognostic factor. Result: The study group consisted of 138 male & female, with the mean age being 48.9 ± 29.4 years, ranging between 02 and 75 years. The mechanisms of injury were traffic accidents in 33 (35%); fall in 42 (45%) and blunt injury due to occupational accidents in 17 (20%) patients. Left hemispheric injury was found in 39 (42%); right hemispheric injury in 42 (45%); and bilateral hemispheric injury in 11 (13%) patients. Acute SDH was the only injury in 27 (30%) patients, while the remaining 65 (70%) had accompanying extracranial injuries. Conclusion: Craniotomy can have favorable outcome in few cases of Acute SDH with unfavorable pre operative status, although craniectomy remain the standard surgical modality with pre operative poor clinical status. Early decompression in Acute SDH may be of particular benefit. The age of the patients, pupillary size and reaction at the time of admission was statistically significant predictor of outcome. Though, the indications of Decompressive Craniectony versus Craniotomy remain a matter of debate; the Brain Trauma Foundation has identified the question of craniotomy versus decompressive craniectomy for primary evacuation of AcSDH as an vital area for further research.

Keywords: Traumatic Brain Injury; Decompressive Craniectomy; Acute subdural heamatoma; Outcome; Glasgow coma scale.

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Cite this article

I.D. Chaurasia, Jay Prakash Singour, Agam Sharma et al. Role of Decompressive Craniectomy in Acute Subdural Haematoma. Int J Neurol Neurosurg. 2019;11(2):109-113.

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.11219.1

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