Outcomes of Evacuating Subacute Extradural Hematoma Through a Minicraniectomy: A 5-Year Study

IF 0.2 Q4 NEUROSCIENCES Indian Journal of Neurotrauma Pub Date : 2023-01-18 DOI:10.1055/s-0043-1760742
B. Usman, B. Mohammed, Usman Daibu
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Abstract

Abstract Background  Extradural hematoma (EDH) is a hematoma between the dura and the inner surface of the skull, found in 1 to 3% of all head-injured patients, rising to 9% among the unconscious ones. It is said to be subacute when about 2 to 4 days old. Further enlargement of the burr hole to about 3 to 5 cm wide (minicraniectomy) may allow its total evacuation. Objective  To recommend it as a treatment option, this study aims to evaluate the surgical outcomes of evacuating a subacute EDH through a minicraniectomy. Method  This was a 5-year prospective study in a Nigerian tertiary health institution. Results  In total, 108 patients, consisting of 96 males and 12 females with a male to female ratio of 8:1 were included. Their ages ranged from 10 to 69 years. Etiologies were road traffic accident (RTA, 73.2%), assault (18.5%), and falls (8.3%). Hematoma ages were 2 days (61.1%), 3 days (25%), 4 days (13.9%). GCS were mild (11%), moderate (56%), and severe (33%). Locations were right-sided (59.3%), left-sided (40.7%) with 73.1% in parietotemporal area. Active bleeding was encountered in 15% only. Postoperative complications were seizure (13.9%), death (12%), and surgical site infection (4.6%) among others. Outcomes at 2 weeks were good (83, 76.9%), moderate disability (12, 11.1%), severe disability (10, 9.3%), vegetative (1, 0.9%), and death (2, 1.9%). Conclusion  Considering the significant morbidity and mortality and the need for urgent interventions in EDH, most patients presenting in the subacute acute (2– 4 days) stage can be evacuated via a minicraniectomy with good outcomes.
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通过小颅骨切除术排出亚急性硬膜外血肿的结果:一项为期5年的研究
硬膜外血肿(EDH)是硬脑膜与颅骨内表面之间的血肿,在所有头部损伤患者中发生率为1%至3%,在无意识患者中上升至9%。出生约2至4天后,被称为亚急性。进一步扩大钻孔至约3至5厘米宽(小颅骨切除术)可使其完全排出。目的:为了推荐它作为一种治疗选择,本研究旨在评估通过小颅骨切除术排出亚急性EDH的手术结果。方法在尼日利亚某三级卫生机构进行为期5年的前瞻性研究。结果共纳入108例患者,其中男性96例,女性12例,男女比例为8:1。他们的年龄从10岁到69岁不等。病因为道路交通事故(RTA, 73.2%)、殴打(18.5%)和跌倒(8.3%)。血肿年龄分别为2天(61.1%)、3天(25%)、4天(13.9%)。GCS分为轻度(11%)、中度(56%)和重度(33%)。发病部位以右侧(59.3%)、左侧(40.7%)为主,其中顶颞区占73.1%。活动性出血仅占15%。术后并发症包括癫痫发作(13.9%)、死亡(12%)和手术部位感染(4.6%)。2周时的结果为良好(83,76.9%)、中度残疾(12,11.1%)、重度残疾(10,9.3%)、植物性残疾(1,0.9%)和死亡(2,1.9%)。结论考虑到EDH显著的发病率和死亡率,以及紧急干预的必要性,大多数亚急性(2 - 4天)期患者可以通过微创手术清除,效果良好。
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