Decompressive Craniectomy (DC) - Comparative Study of 30-Day Mortality in Surgeries of Severe Brain Trauma with Subdural Hematoma, with and without DC

Lucas Eduardo Bonadio; Luis Renato Garcez Mello; Leandro Jose Haas; Vitor Hugo Tamiosso Boer; Celso Itiberê Carvalho Bernardes; Danielle De Lara; Filipe Laurindo Cabral; Gabriel Hoher Peres; Stephanie Lindner

doi:10.1055/s-0036-1596050

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, Table of Contents

CC-BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(01): 21-25
DOI: 10.1055/s-0036-1596050

Original Article | Artigo Original

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Decompressive Craniectomy (DC) - Comparative Study of 30-Day Mortality in Surgeries of Severe Brain Trauma with Subdural Hematoma, with and without DC

Craniectomia descompressiva (CD): estudo comparativo da mortalidade em 30 dias das cirurgias para traumatismo craniano grave com hematoma subdural, com e sem CD

Authors

Lucas Eduardo Bonadio

¹Neurosurgeon, Department of Neurosurgery, Instituto Catarinense de Neurologia e Neurocirurgia, Hospital Santa Isabel, Blumenau, SC, Brazil
Luis Renato Garcez Mello

¹Neurosurgeon, Department of Neurosurgery, Instituto Catarinense de Neurologia e Neurocirurgia, Hospital Santa Isabel, Blumenau, SC, Brazil
Leandro Jose Haas

¹Neurosurgeon, Department of Neurosurgery, Instituto Catarinense de Neurologia e Neurocirurgia, Hospital Santa Isabel, Blumenau, SC, Brazil
Vitor Hugo Tamiosso Boer

¹Neurosurgeon, Department of Neurosurgery, Instituto Catarinense de Neurologia e Neurocirurgia, Hospital Santa Isabel, Blumenau, SC, Brazil
Celso Itiberê Carvalho Bernardes

¹Neurosurgeon, Department of Neurosurgery, Instituto Catarinense de Neurologia e Neurocirurgia, Hospital Santa Isabel, Blumenau, SC, Brazil
Danielle De Lara

¹Neurosurgeon, Department of Neurosurgery, Instituto Catarinense de Neurologia e Neurocirurgia, Hospital Santa Isabel, Blumenau, SC, Brazil
Filipe Laurindo Cabral

²Department of Neurosurgery, Hospital Santa Isabel, Blumenau, SC, Brazil
Gabriel Hoher Peres

²Department of Neurosurgery, Hospital Santa Isabel, Blumenau, SC, Brazil
Stephanie Lindner

²Department of Neurosurgery, Hospital Santa Isabel, Blumenau, SC, Brazil

Abstract

Objective Compare 30 days mortality of patients harboring acute subdural hematomas in two series, one treated only by wide aspiration of hematoma and other with aspiration followed by decompressive craniectomy.

Methods Comparing retrospectively two series of ASD with and without DC. Involved 81 TBI patients with acute subdural hematoma and GCS ≤ 8 (Jan 2000 to Nov 2014) arranged into two groups. Group 1 - 58 cases underwent to DC. Group 2 - 23 patients underwent only hematoma aspiration.

Results Group 1 showed 44.8% mortality directly due to brain lesion within 30 days. The most frequent associated lesion were contusion in 37.2%. Group 2 the mortality within 30 days was 47.8%. The majority of deaths (82%) resulted from uncontrollable brain swelling, midline shift was present in 94.7% of patients.

Conclusion High admission GCS and age less than 50 remain better outcome predictor in 30 days survival for patients undergoing surgery of traumatic ASDH.

Resumo

Objetivo Comparar a mortalidade em 30 dias de pacientes que sofreram hematoma subdural agudo em duas séries, uma tratada por aspiração do hematoma e outro por aspiração seguida de craniectomia descompressiva.

Métodos Comparar retrospectivamente duas séries de HSD com e sem CD. Envolveu 81 pacientes com TCE com hematoma subdural agudo e GCS ≤ 8 (Jan 2000 a Nov 2014) em dois grupos. Grupo 1–58 casos tratados submetidos a CD. Grupo 2–23 pacientes submetidos a drenagem do hematoma somente.

Resultados Grupo 1 apresentou 44,8% de mortalidade diretamente devido a lesão cerebral dentro de 30 dias. A mais comum lesão associada era contusão em 37,2%. Grupo 2 a mortalidade dentro de 30 dias foi 47,8%. A maioria dos óbitos (82) resultou de edema cerebral incontrolável, desvio de linha média estava presente em 94,7% dos pacientes.

Conclusão Alto GCS de admissão e idade menor que 50 anos permanecem melhores preditores de desfecho na mortalidade em 30 dias para paciente submetidas a cirurgia de hematoma subdural agudo.

Keywords

decompressive craniectomy - acute subdural hematoma - mortality

Palavras-chave

craniectomia descompressiva - hematoma subdural agudo - mortalidade

Full Text

References

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