J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A031
DOI: 10.1055/s-0035-1566350

Results of Surgically Treated Acute Subdural Hematoma Caused by Head Injury

Antun Azasevac 1, T. Cigić 1, V. Papić 1, Đ. Đilvesi 1, N. Krajčinović 1, I. Horvat 1, M. Karan 1, B. Jelača 1, J. Golubović 1, M. Fimić 2, I. Meljnikov 2, P. Vuleković 1
  • 1Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia
  • 2Clinic of Pediatric Surgery, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia

Introduction Acute subdural hematoma (aSDH) is one of the most common types of intracranial mass lesions that occurs in approximately one-third of patients with severe traumatic head injuries.

Aim To investigate influence of neurological status on admission and complications after surgery to outcome of surgically treated patients with aSDH.

Material and Methods From January 1, 2013, to June 30, 2015, 100 patients were surgically treated for aSDH. We analyzed age, gender, mechanism of trauma, neurological status on admission valued by Glasgow Coma Scale (GCS), outcome valued by Glasgow Outcome Scale (GOS), associated extracranial and intracranial lesions, comorbidities, and complications. Patients were divided according to GCS—first group: severe TBI (GCS 3–8; 63 patients), second group: moderate TBI (GCS 9–13; 27 patients), and third group: mild TBI (GCS 14–15; 9 patients). Followed-up period was 1 month after surgery, and we analyzed occurrence of next complications: seizures, pneumonia, deterioration of renal failure, urinary infections, gastrointestinal bleeding, meningitis, and sepsis.

Results There were 75 males and 25 females; median age was 61 years. In 72%, the mechanism of injury was fall; 14% were injured in vehicle accidents, 2% by direct injury in violence, and 4% by epileptic seizures. In 61%, aSDH was accompanied with brain contusions, 29% had brain contusions and skull fractures, and 19% had aSDH and multiple extracranial injuries. Next complications occurred during hospitalization: seizures (12%), pneumonia (35%), deterioration of renal failure (7%), urinary infections (8%), gastrointestinal bleeding (1%), meningitis (2%), and sepsis (1%). In the first group, percentage of complications was the highest including 31 of 35 pneumonias, 7 of 7 deterioration of renal failure, 1 of 1 gastrointestinal bleeding, 1 of 1 meningitis, and 1 of 1 sepsis. Overall outcome according to GOS was favorable (GR/MD) in 33 of 100 patients (first group 6, second group 18, third group 9), severely disabled (SD/PVS) in 21 of 100 (first group 21, second group 5, third group 0), and unfavorable (D) in 41 of 100 (first group 37, second group 4, third group 0).

Conclusion aSDH is accompanied by high morbidity and mortality rate due to frequently associated intracranial lesions and nonsurgical systemic complications. Patients with better neurological status on admission have more favorable outcome and less percentage of systemic complications.

Keywords acute subdural hematoma; surgical therapy; outcome