Objective: Acute subdural hematoma (ASDH) has been associated with mortality in traumatic brain
injury. The timing of surgical evacuation for ASDH has still been controversial. The
object of this study was to determine the temporal and clinical factors associated
with outcome following surgery for ASDH. Materials and Methods: The study retrospectively viewed medical records and neuroimaging studies of ASDH
patients who underwent surgical evacuation. Surgical outcomes were dichotomized into
favorable and unfavorable outcomes, and operative times compared between the groups.
Results: The records of 145 ASDH patients who underwent surgery were reviewed. Almost two-thirds
of the patients were admitted for surgical evacuation, of whom 71% underwent a decompressive
operation. The temporal variables were as follows: mean time from scene of accident
to emergency department (ED) was 70 (Standard deviation [SD] 256.0) min, mean time
from ED to obtaining CT of the brain was 45.6 (SD 38.9) min, mean time from brain
computed tomographic to operating room arrival was 68.6 (SD 50.0) min, and mean time
from ED arrival to skin incision was 160.1 (SD 88.1) min. The mean time from ED arrival
to skin incision was significantly shorter in the unfavorable outcome group. Because
of this reverse association between time from ED to surgery, multivariate analysis
was applied to adjust the timing factors with other clinical factors, and the results
indicated that temporal factors were not associated with functional outcome, as features
such as increased intracranial pressure due to obliterated basal cistern and brain
herniation were significantly associated with functional outcome. Conclusions: The optimal times for surgical evacuation of ASDH are challenging to estimate because
compressed brainstem signs are more important than time factors. ASDH patients with
compressed brainstem should have surgery as soon as possible.
Key-words:
Acute subdural hematoma - subdural hematoma - the timing of surgery
