Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects

  • Jan ChrastinaEmail author
  • Čeněk Šilar
  • Tomáš Zeman
  • Michal Svoboda
  • Jan Krajsa
  • Barbora Musilová
  • Zdeněk Novák
Original Article



To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome.


Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery—trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied.


Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients.


Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.


Brain injury Acute subdural hematoma Reoperation Contralateral subdural hematoma Decompressive craniectomy 



The paper was not supported by any grant and received no funding.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.


  1. 1.
    Kwinta BM, Krzyżewski RM, Kliś KM, Donicz P, Gackowska M, Polak J, Stachura K, Moskała M. Emergency reoperations in cranial neurosurgery. World Neurosurg. 2017;105:749–4.CrossRefGoogle Scholar
  2. 2.
    Desai VR, Grossman R, Sparrow H. Incidence of intracranial hemorrhage after a cranial operation. Cureus. 2016;8:e616.Google Scholar
  3. 3.
    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;71:1632–6.CrossRefGoogle Scholar
  4. 4.
    Lenzi J, Caporlingua F, Caporlingua A, Anichini G, Nardone A, Passacantilli E, Santoro A. Relevancy of positive trends in mortality and functional recovery after surgical treatment of acute subdural hematomas. Our 10-year experience. Br J Neurosurg. 2017;31:78–83.CrossRefGoogle Scholar
  5. 5.
    Servadei F, Nasi MT, Giuliani G, Cremonin AM, Cenni P, Zappi D, Taylor GS. CT prognostic factors in acute subdural hematomas. The value of the worst CT scan. Br J Neurosurg. 2000;14:110–6.CrossRefGoogle Scholar
  6. 6.
    Al-Mufti F, Mayer SA. Neurocritical care of acute subdural hemorrhage. Neurosurg Clin N Am. 2017;28(2):267–78.CrossRefGoogle Scholar
  7. 7.
    Han H, Koh EJ, Choi H, Kim BC, Yang SY, Cho KT. The effect of preoperative antiplatelet therapy on hemorrhagic complications after decompressive craniectomy in patients with traumatic brain injury. Korean J Neurotrauma. 2016;12:61–6.CrossRefGoogle Scholar
  8. 8.
    Su TM, Lee TH, Chen WF, Lee TC, Cheng CH. Contralateral acute epidural hematoma after decompressive surgery of acute subdural hematoma: clinical features and outcome. J Trauma. 2008;65:1298–302.CrossRefGoogle Scholar
  9. 9.
    Tomycz ND, Germanwala AV, Walter KA. Contralateral acute subdural haematoma after surgical evacuation of acute subdural hematoma. J Trauma. 2010;68:E2–11.CrossRefGoogle Scholar
  10. 10.
    Matsuno A, Katayama H, Wada H, Morikawa K, Tahala K, Tahala H, Murazaki M, Fuke E, Nagashima T. Significance of consecutive bilateral surgeries for patients with acute subdural haematoma who developed contralateral acute epi - or subdural haematoma. Surg Neurol. 2003;60:23–30.CrossRefGoogle Scholar
  11. 11.
    Flordelís Lasierra JL, García Fuentes C, Toral Vázquez D, Chico Fernández M, Bermejo Aznárez S. Alted López E. Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury. Eur J Trauma Emerg Surg. 2013;39:277–83.CrossRefGoogle Scholar
  12. 12.
    Shen J, Fan Z, Ji T, Pan J, Zhou Y, Zhan R. Contralateral acute subdural haematoma following traumatic acute subdural hematoma evacuation. Neurol Med Chir (Tokyo). 2013;53:221–3.CrossRefGoogle Scholar
  13. 13.
    Kwon H, Choi KS, Yi HJ, Chun HJ, Lee YJ, Kim DW. Risk factors of delayed surgical intervention after conservatively treated acute traumatic subdural Hematoma. J Korean Neurosurg Soc. 2017;60:723–9.CrossRefGoogle Scholar
  14. 14.
    Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, Gravori T, Obukhov D, McBride DQ, Martin NA. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96:109–16.CrossRefGoogle Scholar
  15. 15.
    Panczykowski DM, Okonkwo DO. Premorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas. J Neurosurg. 2011;114:47–52.CrossRefGoogle Scholar
  16. 16.
    Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery. 1994;35:1061–4.CrossRefGoogle Scholar
  17. 17.
    Fabbri A, Servadei BF, Marchesini G, Stein SC, Vandelli A. Predicting intracranial lesion by antiplatelet agents in subjects with mild head injury. J Neurol Neurosurg Psychiatry. 2010;81:1275–9.CrossRefGoogle Scholar
  18. 18.
    Chrastina J, Hrabovský D, Zvarová M, Ríha I, Novák Z. [The effect of anticoagulation and anti-platelet treatment on the extent, development and prognosis of acute craniocerebral injury] [Article in Czech]. Acta Chir Orthop Traumatol Cech. 2014;81:77–84.Google Scholar
  19. 19.
    Moussa WMM, Khedr WM, Elwany AH. Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study. Neurosurg Rev. 2018;41:483–8.CrossRefGoogle Scholar
  20. 20.
    Bartels RH, Meijer FJ, van der Hoeven H, Edwards M, Prokop M. Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality. BMC Neurol. 2015;15:220.CrossRefGoogle Scholar
  21. 21.
    Liu X, Qiu Y, Zhang J, Zhang Q, Chen L, Chen L, Sun X. Emergent single burr hole evacuation for traumatic acute subdural hematoma with cerebral herniation: a retrospective cohort comparison analysis. World Neurosurg. 2018. (Epub ahead of print).Google Scholar
  22. 22.
    Lu T, Guan J, An C. Preoperative trepanation and drainage for acute subdural hematoma: Two case reports. Exp Ther Med. 2015;10(1):225–30.CrossRefGoogle Scholar
  23. 23.
    Endo H, Fukawa O, Mashiyama S, Kawase M. [Single burr hole surgery for acute spontaneous subdural hematoma in the aged: patient reports of three cases]. No Shinkei Geka. 2004;32(3):271–6.Google Scholar
  24. 24.
    Di Rienzo A, Iacoangeli M, Almaro L, Colasanti R, Somma LGMD, Nocchi N, Gladi M, Scerrati M. Mini-craniotomy under local anesthesia to treat acute subdural haematoma in deteriorating elderly patient. J Neurol Surg A Centr Eur Neurorosurg. 2017;78:535–40.CrossRefGoogle Scholar
  25. 25.
    Yokosuka K, Uno M, Matsumura K, Takai H, Hagino H, Matsushita N, Matsubara S. Endoscopic haematoma evacuation for acute and subacute subdural hematoma in elderly patient. J Neurosurg. 2015;123:1065–9.CrossRefGoogle Scholar
  26. 26.
    Li X, von Holst H, Kleiven S. Decompressive craniectomy causes a significant strain increase in axonal fiber tracts. J Clin Neurosci. 2013;30:509–13.CrossRefGoogle Scholar
  27. 27.
    Vilcinis R, Bunevicius A, Tamasauskas A. The association of surgical method with outcomes of acute subdural hematoma patients: experience with 643 consecutive patients. World Neurosurg. 2017;101:335–42.CrossRefGoogle Scholar
  28. 28.
    Tsermoulas G, Shah O, Wijesinghe HE, Silva AH, Ramalingam SK, Belli A. Surgery for acute subdural hematoma: replace or remove the bone flap? World Neurosurg. 2016;88:569–75.CrossRefGoogle Scholar
  29. 29.
    Kim H, Suh SJ, Kang HJ, Lee MS, Lee YS, Lee JH, Kang DG. Predictable values of decompressive craniectomy in patients with acute subdural hematoma: comparison between decompressive craniectomy after craniotomy group and craniotomy only group. Korean J Neurotrauma. 2018;14(1):14–9.CrossRefGoogle Scholar
  30. 30.
    Zhao HX, Liao Y, Xu D, Wang QP, Gan Q, You C, Yang CH. The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions. BMC Surg. 2015;15:111.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Faculty of Medicine, St. Anne’s Hospital BrnoMasaryk UniversityBrnoCzech Republic
  2. 2.Institute of Biostatistics and AnalysesMasaryk University Medical FacultyBrnoCzech Republic
  3. 3.Faculty of Medicine, Institute of Forensic MedicineMasaryk UniversityBrnoCzech Republic

Personalised recommendations