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

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.

Comparing surgical outcomes: Craniotomy versus decompressive craniectomy in acute subdural hematoma - A systematic review and meta-analysis

“…Consequently, they were assessed for eligibility and full-text screening, which led to the inclusion of 17 studies. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 The searching and screening process is shown in the flowchart ( Fig. 1 ).…”

“…More data is needed to standardize care since the situations that fall in between the two extremes are those in which surgeons retain discretion over the procedure they choose. 6 Therefore a systematic review and meta-analysis was performed to address the relative outcomes and complications of craniotomy when compared to decompressive craniectomy for acute SDH.…”

Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article

“…1 ). 2 7 16 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 In the 42 articles within the quantitative analysis, 34 articles included patients operated on for ASDH, 2 16 24 25 26 27 30 31 33 34 35 37 38 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 …”

“…Nine point eight percent (4/41) of the studies, accounting for 945 patients, reported differences in baseline characteristics, brain CT features, and outcomes between patients who underwent craniotomy or DC. 40 48 50 61 Compared to patients who underwent craniotomy, patients who underwent DC were more likely to be younger (significant n = 734, p = 0.015; nonsignificant p = 46), to suffer from extra-cerebral-associated trauma lesions (significant n = 91, p = 0.001), to have a lower admission GCS score (significant n = 780, p = 0.034), and to present abnormal pupil examination (significant n = 46, p = 0.004). Patients who underwent DC were more likely to harbor serious brain CT scan features, such as important ASDH thickness (significant n = 808, p = 0.031), important midline shift (significant n = 808, p = 0.01), traumatic subarachnoid hemorrhage (significant n = 46, p = 0.003), and loss of basal cisterns (significant n = 256, p = 0.02).…”

“…1). 2,7,16, In the 42 articles within the quantitative analysis, 34 articles included patients operated on for ASDH, 2,16,[24][25][26][27]30,31,[33][34][35]37,38,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][57][58][59][60][61] whereas seven articles included ASDH patients managed either medically or surgically. 7,28,29,32,36,39,56…”