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One hundred and twenty-seven cases of acute subdural haematoma operated on

Correlation between CT scan findings and outcome

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Traumatic acute subdural haematoma is one of the most lethal of all head injuries: the mortality rate is reported to be between 50 and 90%. We reviewed the clinical records of 1688 head injured patients admitted to the Department of Neurosurgery at C.T.O. hospital between 1982 and 1992. In 127 cases (7,5%) CTscan on admission showed acute subdural haematoma requiring surgery because the midline shift was greater than 5 mm.

The overall mortality rate was 57% and 23% had functional recovery.

The following variables were assessed with regard to morbidity and mortality: mechanism of injury, age, neurological presentation, time delay from injury to intervention, CTscan finding on admission. GCS and CTscan findings were found to be the most important prognostic variable. Timing of operative intervention for clot removal with regard to outcome was not statistically significant. But no conclusions regarding the importance of early haematoma evacuation can be drawn from such an oversimplifying statement, because it does not take into account factors like rapidity of haematoma development and related brain decompensation as well as additional direct brain lesions.

The results of this study suggest that the extent of primary brain injury underlying the subdural haematoma is the most important factor affecting outcome.

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  1. Adams JH, Graham DI, Scott Get al (1980) Brain damage in fatal non-missile head injury. J Clin Pathol 33: 1132–1145

    PubMed  Google Scholar 

  2. Adams JH, Gennarelli TA, Graham DI (1982) Brain damage in non-missile head injury: observations in man and sub-human primates. In: Smith WT, Cavanagh B (eds) Recent advances in neuropathology, vol II. Churchill-Livingstone, London, pp 165–190

    Google Scholar 

  3. Cantore GP, Delfini R, Neri J (1987) Contribution to the surgical treatment of acute subdural haematomas. Acta Neurochir (Wien) 41: 349–353

    Google Scholar 

  4. Cooper PR, Rovit RL, Ransohoff J (1976) Hemicraniectomy in the treatment of acute subdural haematoma: a re-appraisal. Surg Neurol 5: 25–28

    PubMed  Google Scholar 

  5. Fell D, Fitzgerald S, Moel RHet al (1975) Acute subdural haematomas. Review of 144 cases. J Neurosurg 42: 37–42

    PubMed  Google Scholar 

  6. Gennarelli TA, Thibault LE (1982) Biomechanics of acute subdural haematoma. J Trauma 22: 680–685

    PubMed  Google Scholar 

  7. Gennarelli TA, Spielman GL, Langfit TWet al (1982) Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56: 26–32

    PubMed  Google Scholar 

  8. Graham DI, Adams JH, Doyle D (1968) Ischaemic brain damage in fatal non-missile head injury. J Neurol Sci 39: 213–234

    Google Scholar 

  9. Haselberger K, Pucher R, Auer LM (1988) Prognosis after acute subdural or epidural haematoma. Acta Neurochir Wien 90: 111–116

    PubMed  Google Scholar 

  10. Howard MA III, Gross AS, Dacey RG jret al (1989) Acute subdural haematomas: an age-dependent clinical entity. J Neurosurg 71: 858–863

    PubMed  Google Scholar 

  11. Jamieson KG, Yelland JDN (1972) Surgically treated traumatic subdural haematomas. J Neurosurg 37: 137–149

    PubMed  Google Scholar 

  12. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484

    PubMed  Google Scholar 

  13. Klun B, Fettich M (1984) Factors influencing the outcome in acute subdural haematoma. A review of 330 cases. Acta Neurochir (Wien) 71: 171–178

    Google Scholar 

  14. Kotwica Z, Brzezinski J (1993) Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien) 121: 95–99

    Google Scholar 

  15. Loew F, Wustner S (1960) Diagnose, Behandlung und Prognose der traumatischen Hämatome des Schädelinneren. Acta Neurochir Wien [Suppl 3]

  16. Mathew P, Oluoch-Olunya DL, Condon BR, Bullock R (1993) Acute subdural haematoma in the conscious patients: outcome with initial non-operative management. Acta Neurochir (Wien) 121: 100–108

    Google Scholar 

  17. McKissock W, Richardson A, Bloom WH (1960) Subdural haematoma. A review of 389 cases. Lancet 1: 1365–1369

    Google Scholar 

  18. Schisano G, Burzaco J (1964) Acute and subacute subdural haematomas. Acta Chir Scand 128: 471–482

    PubMed  Google Scholar 

  19. Seelig JM, Becker DP, Miller ID (1981) Traumatic acute subdural haematoma. Major mortality reduction in comatose patients treated within four hours. N Engl J Med 304: 1511–1518

    PubMed  Google Scholar 

  20. Shenkin HA (1982) Acute subdural haematoma. Review of 39 consecutive cases with high incidence of cortical artery rupture. J Neurosurg 57: 254–257

    PubMed  Google Scholar 

  21. Stone JL, Rifau MHS, Sugar Oet al (1983) Subdural haematomas. 1. Acute subdural haematoma: progress in definition, clinical pathology and therapy. Surg Neurol 19: 216–231

    PubMed  Google Scholar 

  22. Talalla A, Morin MA (1971) Acute traumatic subdural haematoma. A review of one hundred consecutive cases. J Trauma 11: 771–777

    PubMed  Google Scholar 

  23. Wilberger JE, Harris M, Diamond DI (1991) Acute subdural haematoma: morbidity, mortality and operative timing. J Neurosurg 74: 212–218

    PubMed  Google Scholar 

  24. Wintzen AR (1980) The clinical course of subdural haematoma. Brain 103: 855–867

    PubMed  Google Scholar 

  25. Yue CP, Mann KS, Ong GB (1983) Acute subdural haematoma: better results with neurosurgeons than general surgeons. Injury 14: 489–492

    PubMed  Google Scholar 

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Massaro, F., Lanotte, M., Faccani, G. et al. One hundred and twenty-seven cases of acute subdural haematoma operated on. Acta neurochir 138, 185–191 (1996).

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