Craniotomy versus decompressive craniectomy: management of acute subdural hematoma post-traumatic at CHU-JRA

Background: Acute subdural hematoma is one of the frequent complications of severe head trauma, it is a neurosurgical emergency. The aim of this study is to determine and evaluate the outcome of patients operated by craniotomy versus decompressive craniectomy. Methods: This is a retrospective and analytical study over two years from January 01, 2019 to December 31, 2020. Results: 73 patients were included in the study including 63 men and 10 women with a sex ratio of 6.3. The average age was 37.84 years old. The traffic accident was the most common in 47.95% of cases. Of the 73 patients, 54 under went decompressive craniectomy and 19 had craniotomy. The predominant initial Glasgow score in the decompressive craniectomy was less than 8 and in the craniotomy between 13-15. The mean hematoma thickness was 9.54 mm for the decompressive craniectomy and 11.07 mm for the craniotomy. The mean deviation from the midline of the decompressive craniectomy was 7.25 mm and 7.21 mm for the craniotomy. The mortality rate found in décompressive craniectomy was 46.30% and 52.63% for craniotomy. Conclusions: There is no consensus in the literature on the surgical technique, so the management of acute subdural hematoma depends on the expertise of the neurosurgeon on a case-by-case. In order to determine a surgical strategy, a prospective study is necessary.