A randomized study of urgent computed tomography–based hematoma puncture and aspiration in the emergency department and subsequent evacuation using craniectomy versus craniectomy only

Xiao, Bo; Wu, Fangfang; Zhang, Hong; Ma, Yan-Bin

doi:10.3171/2012.5.jns111611

Cited by 12 publications

(12 citation statements)

References 20 publications

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“…Additionally, recent retrospective studies have suggested a possible role for craniectomy in ameliorating increased ICP caused by ICH. [230][231][232][233][234] In addition, the current recommendations do not apply to intracranial hemorrhage caused by trauma or underlying structural lesions such as aneurysms and arteriovenous malformations, because these patients were not included in the described ICH surgery trials.…”

Section: Surgical Treatment Of Ich (Clot Removal)mentioning

confidence: 99%

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Hemphill¹,

Greenberg²,

Anderson³

et al. 2015

Stroke

2,890

1,196

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2032Purpose-The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. Methods-A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Results-Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions-Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted.These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

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Section: Surgical Treatment Of Ich (Clot Removal)mentioning

confidence: 99%

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Hemphill¹,

Greenberg²,

Anderson³

et al. 2015

Stroke

2,890

1,196

View full text Add to dashboard Cite

show abstract

“…However, several factors including the old age, APT, and/or comorbid burden need attentions before appropriate surgical procedures were performed. It was reported that TDC could help to prevent subsequent brain injury, assist in stabilizing the clinical condition, and improve the outcome of TBI patients, and it has been chosen for saving valuable time in the patients with TASDH before the evacuation of subdural hematoma via large craniotomy or decompressive craniectomy [1].…”

Section: Discussionmentioning

confidence: 99%

“…The mean duration of TDC in this study was 14.4 min (6-19 min). Therefore, TDC was more suitable to apply for emergency situations, and when it was combined with other surgical treatment such as subsequent craniotomy, it would provide a more safe, feasible, and effective surgical option than craniotomy only [1]. However, few reports showed that acute subdural hematomas were successfully removed with TDC alone or combined with the instillation of urokinase.…”

Section: Discussionmentioning

confidence: 99%

Twist drill craniostomy for traumatic acute subdural hematoma in the elderly: case series and literature review

Huang

Sun²,

Xie

et al. 2019

Chin Neurosurg Jl

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Background: A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma (TASDH). To date, few studies have reported that TASDH could be successfully treated by twist drill craniostomy (TDC) alone or combined with instillation of urokinase. We aimed to define the TDC for the elderly with TASDH and performed literature review. Case presentation: A total of 7 TASDH patients, who were presented and treated by TDC in this retrospective study between January 2009 and May 2017, consisted of 5 men and 2 women, ranging in age from 65 to 89 (average, 78.9) years. The patients' baseline characteristics, including age, sex, medical history, received ventriculoperitoneal shunt for hydrocephalus or not, reason for avoiding or refusing large craniotomy, preoperative Glasgow Coma Scale (GCS), suffered from cerebral herniation or not, the location of TASDH, imaging characteristics of TASDH in CT scan, injury/surgery time interval, midline shift, preoperative neurologic deficit, operation time, and infusions of urokinase or not, were collected. The postoperative GCS, postoperative neurologic deficit, rebleeding or not, intracranial infection, and modified Rankin Scale (mRS) at 6 months after surgery were analyzed to access the safety and efficacy of evacuation with TDC. The results showed that the mean time interval from injury to TDC was 68.6 min (30-120 min). The mean distance of midline shift was 14.6 mm (10-20 mm). The preoperative GCS in all patients ranged from 4 to 13 (median, 9). The mean duration of the operation was 14.4 min (6-19 min). Postoperative CT scan showed that hematoma evacuation rate was more than 70% in all cases. There were no cases of acute rebleeding and intracranial infection after TDC. No cases presented with chronic SDH at the ipsilateral side within 6 months after being treated by TDC alone or combined with instillation of urokinase. Favorable outcomes were shown in all cases (mRS scores 0-2) at 6 months after surgery. Conclusions: TASDH in the elderly could be safely and effectively treated by TDC alone or combined with instillation of urokinase, which was a possible alternative for the elderly.

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“…Among the survivors, improvements in GCS score of more than three points, compared to preoperative measurement, were more frequently observed among the early (less than 3 hours between trauma onset and operation) decompressed cases ( p =0.013). Similarly, Xiao et al 41) in addressing the effect of DC on long-term functional outcomes, discerned that early decompression should be performed in patients before herniation occurs. Additionally, Csókay et al 10) also reported the importance of very early DC in the aspect of ICP increase prevention in children with severe traumatic brain swelling.…”

Section: Discussionmentioning

confidence: 99%

“…The pupil diameter was measured using a millimeter ruler, and a fixed pupil was defined as a constriction of less than 1 mm when the light reflex was checked. Based on this definition, brain stem compression was defined as a pupil grade of less than 3, as categorized by Xiao et al 41) Pupil grade was categorized as either Grade 0, bilaterally fixed pupils; Grade 1, unilaterally fixed with a fixed pupil diameter >7 mm; Grade 2, unilaterally fixed with a fixed pupil ≤7 mm; Grade 3, unilaterally sluggish; Grade 4, a bilaterally brisk response; or Grade 5, normal response. The length of time between trauma onset and decompression was obtained by reviewing information recorded by the National 119 Rescue Service and operation records.…”

Section: Methodsmentioning

confidence: 99%

Early Decompression of Acute Subdural Hematoma for Postoperative Neurological Improvement: A Single Center Retrospective Review of 10 Years

Oh¹,

Shim

Yoon

et al. 2016

Korean J Neurotrauma

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ObjectiveThis study was conducted to investigate survival related factors, as well as to evaluate the effects of early decompression on acute subdural hematoma (ASDH).MethodsWe retrospectively reviewed cases of decompressive craniectomy (DC) for decade. In total, 198 cases of DC involved ASDH were available for review, and 65 cases were excluded due to missing data on onset time and a delayed operation after closed observation with medical care. Finally, 133 cases of DC with ASDH were included in this study, and various factors including the time interval between trauma onset and operation were evaluated.ResultsIn the present study, survival rate after DC in patients with ASDH was shown to be related to patient age (50 years old, p=0.012), brain compression ratio (p=0.042) and brain stem compression (p=0.020). Sex, preoperative mental status, and time interval between trauma onset and operation were not related with survival rate. Among those that survived (n=78), improvements in Glasgow Coma Scale (GCS) score of more than three points, compared to preoperative measurement, were more frequently observed among the early (less than 3 hours between trauma onset and operation) decompressed cases (p=0.013). However, improvements of more than 4 or 5 points on the GCS were not affected by early decompression.ConclusionEarly decompression of ASDH was not correlated with survival rate, but was related with neurological improvement (more than three points on the GCS). Accordingly, early decompression in ASDH, if indicated, may be of particular benefit.

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A randomized study of urgent computed tomography–based hematoma puncture and aspiration in the emergency department and subsequent evacuation using craniectomy versus craniectomy only

Cited by 12 publications

References 20 publications

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Twist drill craniostomy for traumatic acute subdural hematoma in the elderly: case series and literature review

Early Decompression of Acute Subdural Hematoma for Postoperative Neurological Improvement: A Single Center Retrospective Review of 10 Years

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