Clinical Features and Outcomes of Bilateral Decompression Surgery for Immediate Contralateral Hematoma after Craniectomy Following Acute Subdural Hematoma

Abstract

Objective: Immediate contralateral epidural hematoma (EDH) and traumatic intracerebral hematoma (T-ICH) after craniectomy for traumatic subdural hematoma (SDH) are rare but devastating post-operative complications. Their clinical features and outcomes are not well studied. In this report, we present the clinical features and outcomes of immediate contralateral acute hematoma cases requiring a second operation. Methods: This study includes 10 cases of immediate contralateral EDH and T-ICH following bilateral craniectomy for theevacuation of traumatic SDH and contralateral hematoma between 2004 and 2015. Their medical records and radiographicfndings were reviewed and analyzed retrospectively. Results: Ten of the 528 patients (1.89%) who underwent craniectomy for the evacuation of traumatic SDH developed postoperative EDH (n=5), T-ICH (n=5). The trauma was caused by a fall in 5 patients and by a traffc accident in 5 patients. Thepatients who suffered trauma due to pedestrian accidents died. Seven patients had a low admission Glasgow Coma Scale(GCS; GCS≤8) score in the preoperative state (average admission GCS, 7.7; average discharge GCS, 3.4; and average discharge Glasgow Outcome Scale, 2.0). Severe intra-operative brain swelling was noted in all patients, while skull fracturewas observed in 8. Multiple associated injuries and medication for heart disease were characteristic of patients who died. Conclusion: The prognosis of delayed contralateral hematoma was very poor. Multiple associated injuries, past medicalhistory and traffc accidents, especially pedestrians were seemed to be associated with higher mortality rates. Finally,contralateral skull fractures can indicate high risk of delayed contralateral acute intracranial hematoma.