Emergent Single Burr Hole Evacuation for Traumatic Acute Subdural Hematoma with Cerebral Herniation: A Retrospective Cohort Comparison Analysis

Xuemeng Liu, Yongyi Qiu, Jibo Zhang, Qingwen Zhang, Lin Chen, Lizhu Chen, Xiangyu Sun
World Neurosurgery 2018, 120: e1024-e1030

OBJECTIVE: To investigate the clinical benefits of emergent single burr hole evacuation technology in traumatic acute subdural hematoma (ASDH) with cerebral herniation cases.

METHODS: We conducted a review comparing patients with ASDH with cerebral herniation who underwent single burr hole evacuation followed by decompressive craniectomy and intracranial hematoma removal surgery (n = 45, group A) and those who underwent decompressive craniectomy and intracranial hematoma removal surgery after rapid infusion of mannitol 250 mL (n = 53, group B) in our institution. Pre- and postoperative assessments included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), activities of daily living (ADLs), and common complication incidences.

RESULTS: At 1 and 6 months after operation, the median GCS score of group A was significantly higher than group B (P = 0.04 and P = 0.03, respectively). After 6 months, the GOS score and ADLs between the 2 groups had significant differences (P < 0.05). There were no differences between the 2 groups in the common complication incidences.

CONCLUSIONS: Emergent single burr hole evacuation in combination with decompressive craniectomy surgery is a useful treatment for ASDH with cerebral herniation, which can achieve reduction of intracranial pressure as soon as possible and improve the prognosis.

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