Hemicraniectomy in the management of acute subdural hematoma

Abstract

✓ Acute subdural hematomas requiring surgical drainage as a life-saving procedure shortly after injury have been associated with mortality rates as high as 90%. Important factors include early diagnosis, complete clot removal, control of active bleeding, and provision for control of subsequent cerebral edema. In a series of 35 patients who had large, unilateral acute subdural hematomas and were unconscious and decerebrate, the mortality rate was reduced to 60%, and 28% returned to normal activity, through the use of a radical procedure. Following establishment of airway and intravenous Mannitol, emergency angiography was carried out to demonstrate the exact intracranial pathology. A hemicranial bone flap was utilized to aid in clot removal and control of hemorrhage from bridging veins and/or cerebral lacerations. The bone flaps were discarded and the dura not closed to afford postoperative decompression. Plating of the skull defects was carried out at a later date when indicated.