Skip to main content

Advertisement

SpringerLink
Log in

Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The development of a contralateral extraaxial hematoma has repeatedly been described in small series and descriptive studies. However, the evidence available to date is limited.

Objectives

To evaluate the incidence and risk factors leading to the development of a contralateral extraaxial hematoma and to describe the characteristics of cases.

Methods

A retrospective cohort study with prospective data collection was undertaken. All patients admitted to an intensive care unit (ICU) from 2006 to 2010 were studied. The inclusion criteria were as follows: severe trauma [Injury Severity Score (ISS ≥ 16)], neurosurgery (NeuroSx) in the first 24 h. The following were excluded: subacute/chronic subdural hematomas, first bilateral NeuroSx. Cases were those who required immediate contralateral NeuroSx after the first NeuroSx due to the occurrence of a new extraaxial injury or significant growth of a previous one. Controls were those patients those who did not require second NeuroSx or who required reoperation due to ipsilateral lesions. The variables considered were: demographics, neurological assessment, traumatic injuries and severity, image and surgical findings, clinical course, and outcome. Statistics analysis comprised descriptive, inferential, and multivariate analysis by logistic regression.

Results

A total of 120 patients were included, among which there were 11 cases (incidence 9.2 %). The cases showed a significantly higher frequency of coma or severe traumatic brain injury (TBI) at admission, contralateral injury and contralateral skull fracture in the preoperative computed tomography (CT) scan, as well as decompressive craniectomy. There were no significant differences in the severity scores, clinical course, or outcomes. The presence of contralateral fracture was identified as an independent risk factor [relative risk (RR) 47.9, 95 % confidence interval (CI) 5.2–443].

Conclusions

Contralateral extraaxial hematoma is a rare entity, although it has a high mortality rate. Therefore, it requires a high index of suspicion, especially in patients with severe TBI, with minimal contralateral injury and mainly with contralateral skull fracture on the initial CT scan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Koulouris S, Rizzoli HV. Acute bilateral extradural hematoma: case report. Neurosurgery. 1980;7:608–10.

    Article  PubMed  CAS  Google Scholar 

  2. Piepmeier JM, Wagner FC Jr. Delayed post-traumatic extracerebral hematomas. J Trauma. 1982;22:455–60.

    Article  PubMed  CAS  Google Scholar 

  3. Lesoin F, Viaud C, Pruvo J, Redford H, Jomin M. Traumatic and alternating delayed intracranial hematomas. Neuroradiology. 1984;26:515–6.

    Article  PubMed  CAS  Google Scholar 

  4. Reale F, Biancotti R. Acute bilateral epidural hematoma. Surg Neurol. 1985;24:260–2.

    Article  PubMed  CAS  Google Scholar 

  5. Koga H, Mori K, Kurihara M, Sakai S. Traumatic bilateral epidural hematomas presenting at different times in a patient with large ventricles. Surg Neurol. 1985;24:272–4.

    Article  PubMed  CAS  Google Scholar 

  6. Borovich B, Braun J, Guilburd JN, Zaaroor M, Michich M, Levy L, et al. Delayed onset of traumatic extradural hematoma. J Neurosurg. 1985;63:30–4.

    Article  PubMed  CAS  Google Scholar 

  7. Meguro K, Kobayashi E, Maki Y. Acute brain swelling during evacuation of subdural haematoma caused by delayed contralateral extradural hematoma: report of two cases. Neurosurgery. 1987;20:326–8.

    Article  PubMed  CAS  Google Scholar 

  8. Thibodeau M, Melanson D, Ethier R. Acute epidural hematoma following decompressive surgery of a subdural hematoma. Can Assoc Radiol J. 1987;38:52–3.

    PubMed  CAS  Google Scholar 

  9. Feuerman T, Wackym PA, Gade GF, Lanman T, Becker D. Intraoperative development of contralateral epidural hematoma during evacuation of traumatic extraaxial hematoma. Neurosurgery. 1988;23:480–4.

    Article  PubMed  CAS  Google Scholar 

  10. Ban M, Agawa M, Fukami T. Delayed evolution of post-traumatic contralateral extracerebral hematoma after evacuation of initial hematoma. Neurol Med Chir (Tokyo). 1991;31:927–30.

    Article  CAS  Google Scholar 

  11. Matsuno A, Katayama H, Wada H, Morikawa K, Tanaka K, Tanaka H, et al. Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma. Surg Neurol. 2003;60:23–30.

    Article  PubMed  Google Scholar 

  12. Mohindra S, Mukherjee KK, Gupta R, Chhabra R, Gupta SK, Khosla VK. Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: a report of two cases and review of literature. Br J Neurosurg. 2005;19:490–4.

    Article  PubMed  CAS  Google Scholar 

  13. 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(6):1298–302.

    Article  PubMed  Google Scholar 

  14. Cohen JE, Rajz G, Itshayek E, Umansky F. Bilateral acute epidural hematoma after evacuation of acute subdural hematoma: brain shift and the dynamics of extraaxial collections. Neurol Res. 2004;26:763–6.

    Article  PubMed  Google Scholar 

  15. Brain Trauma Foundation. 2007. Guidelines for the management of severe traumatic brain injury. 3rd ed. http://www.braintrauma.org/pdf/protected/Guidelines_Management_2007w_bookmarks.pdf. Accessed 31 Oct 2012.

  16. Stiver SI. Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus. 2009;26(6):E7.

    Article  PubMed  Google Scholar 

  17. Lang JK, Ludwig HC, Mursch K, Zimmerer B, Markakis E. Elevated cerebral perfusion pressure and low colloid osmotic pressure as a risk factor for subdural space-occupying hygromas? Surg Neurol. 1999;52:630–7.

    Article  PubMed  CAS  Google Scholar 

  18. Jeon SW, Choi JH, Jang TW, Moon SM, Hwang HS, Jeong JH. Risk factors associated with subdural hygroma after decompressive craniectomy in patients with traumatic brain injury: a comparative study. J Korean Neurosurg Soc. 2011;49(6):355–8.

    Google Scholar 

  19. Aarabi B, Chesler D, Maulucci C, Blacklock T, Alexander M. Dynamics of subdural hygroma following decompressive craniectomy: a comparative study. Neurosurg Focus. 2009;26(6):E8.

    Article  PubMed  Google Scholar 

  20. Huang APH, Chen YC, Hu CK, Lin TK, Huang SJ, Tu YK, et al. Intraoperative sonography for detection of contralateral acute epidural or subdural hematoma after decompressive surgery (letter). J Trauma. 2011;70(6):1578–9.

    Article  PubMed  Google Scholar 

  21. Petersen OF, Espersen JO. Extradural hematomas: measurement of size by volume summation on CT scanning. Neuroradiology. 1984;26:363–7.

    Article  PubMed  CAS  Google Scholar 

  22. Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet. 1975;1:480–4.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We are indebted to the staff of the Trauma Intensive Care Unit (TICU) of Hospital Universitario 12 de Octubre, who have made this study possible.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain

    J. L. Flordelís Lasierra, C. García Fuentes, D. Toral Vázquez, M. Chico Fernández, S. Bermejo Aznárez & E. Alted López

  2. Paseo de Las Acacias 30, block 4, floor 8th-A, 28005, Madrid, Spain

    J. L. Flordelís Lasierra

Authors
  1. J. L. Flordelís Lasierra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. García Fuentes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Toral Vázquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Chico Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Bermejo Aznárez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Alted López
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. L. Flordelís Lasierra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flordelís Lasierra, J.L., García Fuentes, C., Toral Vázquez, D. et al. Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury. Eur J Trauma Emerg Surg 39, 277–283 (2013). https://doi.org/10.1007/s00068-013-0268-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-013-0268-4

Keywords

Search

Navigation