CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(04): 563-567
DOI: 10.1055/s-0042-1758842
Original Article

Craniotomy or Craniectomy for Acute Subdural Hematoma? Difference in Patient Characteristics and Outcomes at a Tertiary Care Hospital

Saad Bin Anis
1   Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
,
Saad Akhtar Khan
1   Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
,
Rida Mitha
1   Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
,
Muhammad Shahzad Shamim
1   Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
› Author Affiliations

Abstract

Objective This article compares the outcomes of patients with traumatic acute subdural hemorrhage (SDH) managed either with craniotomy (CO) or with decompressive craniectomy (DC).

Methods In this single-center, retrospective analysis we included all adult patients with acute traumatic SDH who were treated either using CO or DC. Sixteen-year hospital data was reviewed for patient demographics, injury details, and hospital course. Outcomes were noted in terms of intraoperative blood loss, intensive care unit stay, need for tracheostomy, post-surgery Glasgow Coma Score (GCS; calculated immediately after surgery), delayed GCS (DGCS; calculated 1 week after surgery), and delayed Glasgow Outcome Score (DGOS) after 6 months of surgery. Postoperative complications were noted during hospital stay, while mortality was noted within 6 months of surgery for each patient.

Results Patients who underwent DC were younger (mean age 34.4 ± 16.8 years vs. 42.4 ± 19.9 years in the CO group) (p = 0.006). Patients who underwent DC also had worst degree of traumatic brain injury as per Marshall grade (62.4% patients with Marshall grade 4 in the DC group vs. only 41.2% patients in the CO group) (p = 0.037). Mean size of hematoma was 23.8 ± 24.6 mm in the DC group versus 11.3 ± 8.2 mm in the CO group (p = 0.001). Mean postop GCS was lower in the DC group; 8.0 ± 4 versus 10.8 ± 4 in the CO group (p < 0.001). However, there was no significant difference in DGCS and DGOS between the DC and CO groups (p = 0.76 and 0.90, respectively). Mortality rate was 24 (30.8%) in the DC group versus 18 (20.7%) in the CO group (p = 0.14).

Conclusion The patients who underwent DC were younger, had larger size hematoma, and poor Marshall grade. We did not find any significant difference in the outcomes of CO and DC for management of subdural hematoma.



Publication History

Article published online:
14 December 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Bullock MR, Chesnut R, Ghajar J. et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute subdural hematomas. Neurosurgery 2006;58(3, Suppl):S16–S24, discussionSi-iv
  • 2 Woertgen C, Rothoerl RD, Schebesch KM, Albert R. Comparison of craniotomy and craniectomy in patients with acute subdural haematoma. J Clin Neurosci 2006; 13 (07) 718-721
  • 3 Phan K, Moore JM, Griessenauer C. et al. Craniotomy versus decompressive craniectomy for acute subdural hematoma: systematic review and meta-analysis. World Neurosurg 2017; 101: 677-685.e2
  • 4 Picetti E, Iaccarino C, Servadei F. Letter: Guidelines for the Management of Severe Traumatic Brain Injury Fourth Edition. Neurosurgery 2017; 81 (01) E2-E2
  • 5 Kwon YS, Yang KH, Lee YH. Craniotomy or decompressive craniectomy for acute subdural hematomas: surgical selection and clinical outcome. Korean J Neurotrauma 2016; 12 (01) 22-27
  • 6 Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Can J Surg 2008; 51 (05) 339-345
  • 7 Godil SS, Shamim MS, Enam SA, Qidwai U, Qadeer M, Sobani ZA. Cranial reconstruction after decompressive craniectomy: prediction of complications using fuzzy logic. J Craniofac Surg 2011; 22 (04) 1307-1311
  • 8 Waqas M, Shamim MS, Enam SF. et al. Predicting outcomes of decompressive craniectomy: use of Rotterdam Computed Tomography Classification and Marshall Classification. Br J Neurosurg 2016; 30 (02) 258-263
  • 9 Kolias AG, Belli A, Li LM. et al. Primary decompressive craniectomy for acute subdural haematomas: results of an international survey. Acta Neurochir (Wien) 2012; 154 (09) 1563-1565
  • 10 Kolias AG, Scotton WJ, Belli A. et al; UK Neurosurgical Research Network, RESCUE-ASDH collaborative group. Surgical management of acute subdural haematomas: current practice patterns in the United Kingdom and the Republic of Ireland. Br J Neurosurg 2013; 27 (03) 330-333
  • 11 Sawauchi S, Abe T. The effect of haematoma, brain injury, and secondary insult on brain swelling in traumatic acute subdural haemorrhage. Acta Neurochir (Wien) 2008; 150 (06) 531-536 , discussion 536
  • 12 Sawauchi S, Murakami S, Ogawa T, Abe T. Acute subdural hematoma associated with diffuse brain injury: analysis of 526 cases in Japan neurotrauma data bank [in Japanese]. No Shinkei Geka 2007; 35 (01) 43-51
  • 13 Cooper DJ, Rosenfeld JV, Murray L. et al; DECRA Trial Investigators, Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364 (16) 1493-1502
  • 14 Hutchinson PJ, Kolias AG, Timofeev IS. et al; RESCUEicp Trial Collaborators. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 2016; 375 (12) 1119-1130
  • 15 Sobani ZA, Shamim MS, Zafar SN. et al. Cranioplasty after decompressive craniectomy: an institutional audit and analysis of factors related to complications. Surg Neurol Int 2011; 2: 123
  • 16 Sawauchi S, Murakami S, Ogawa T, Abe T. Mechanism of injury in acute subdural hematoma and diffuse brain injury: analysis of 587 cases in the Japan Neurotrauma Data Bank [in Japanese]. No Shinkei Geka 2007; 35 (07) 665-671
  • 17 Rush B, Rousseau J, Sekhon MS, Griesdale DE. Craniotomy versus craniectomy for acute traumatic subdural hematoma in the United States: a national retrospective cohort analysis. World Neurosurg 2016; 88: 25-31
  • 18 Li LM, Kolias AG, Guilfoyle MR. et al. Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Acta Neurochir (Wien) 2012; 154 (09) 1555-1561
  • 19 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 2011; 71 (06) 1632-1636
  • 20 Kim KH. Predictors for functional recovery and mortality of surgically treated traumatic acute subdural hematomas in 256 patients. J Korean Neurosurg Soc 2009; 45 (03) 143-150
  • 21 Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009; 26 (06) E9
  • 22 Shamim MS, Qadeer M, Murtaza G, Enam SA, Farooqi NB. Emergency department predictors of tracheostomy in patients with isolated traumatic brain injury requiring emergency cranial decompression. J Neurosurg 2011; 115 (05) 1007-1012