Early Postoperative Outcome after Evacuation of Acute Subdural Haematoma – A Comparison of Craniotomy with Decompressive Craniectomy

Open Access

Abstract

Background: Acute subdural hematoma represents a major clinical entity in traumatic brain injury. The mortality of traumatic acute subdural haematoma is high. Craniotomy and decompressive craniectomy are two commonly used surgical techniques for treatment of traumatic acute subdural hematoma but which one is better surgical technique is still under debate. Objective: This study was done to evaluate the surgical outcome of traumatic acute subdural hematoma and to compare the surgical outcome between craniotomy and decompressive craniectomy with evacuation of hematoma. Methods & Materials: A hospital based randomized clinical trial was conducted from July 2016 to December 2017. Total 36 patients with traumatic acute subdural hematoma with pre-operative GCS 5-13, thickness of hematoma more than 10 mm, midline shift more than 5 mm and at least one pupil was reacting to light were included in this study. Data were collected by specially designed case record form and analysed usingStatisticalPackage for Social Sciences (SPSS) version 22.0). Results: Regardless of surgical technique used that is craniotomy (CR) or decompressive craniectomy (DC) with evacuation of hematoma, good recovery (GOS score-5) was 33.3%, moderate disability (GOS score= 4) 19.4%, severe disability (GOS score-3) 5.6%, persistent vegetative state (GOS score-2) 5.6%, and 36.1% patient died after surgery. In CR group according to Glasgow outcome scale (GOS) good recovery was 33.3%, moderate disability 11.1%, severe disability 11.1%, persistent vegetative state 5.6% and 38.9% patients died. In DC group, good recovery was 33.3%, moderate disability 27.8%, severe disability 0%, persistent vegetative state 5.6% and 33.3% patients died. Conclusion: Patients with traumatic acute subdural hematoma with GCS ≥ 9, bilateral reacting pupil and surgery within 24 hours craniotomy (CR) may be an alternative surgical option considering the possible complications of decompressive craniectomy as craniotomy and decompressive craniectomy showed no difference. But patients with poor clinical status and surgery after 24 hours primary decompressive craniectomoy (DC) may be more effective than craniotomy.