Delayed Treatment of Acute Subdural Hematomas: Retrospective Outcome Analysis of 215 Patients

Kanat Akhmetov; Serik Akshulakov; Yerzhan  Adilbekov; Altynshash Jaxybayeva; Mariya Dmitriyeva; Medet Toleubayev

doi:10.3889/oamjms.2021.6566

Authors

Kanat Akhmetov Department of Neurology, Astana Medical University, Nur-Sultan, Kazakhstan; Department of Neurosurgery, National Center for Neurosurgery, Nur-Sultan, Kazakhstan https://orcid.org/0000-0001-6683-3484
Serik Akshulakov Department of Neurosurgery, National Center for Neurosurgery, Nur-Sultan, Kazakhstan https://orcid.org/0000-0003-1781-6017
Yerzhan Adilbekov Department of Neurosurgery, National Center for Neurosurgery, Nur-Sultan, Kazakhstan https://orcid.org/0000-0002-9166-3859
Altynshash Jaxybayeva Department of Neurology, Astana Medical University, Nur-Sultan, Kazakhstan https://orcid.org/0000-0002-8927-7377
Mariya Dmitriyeva Department of General and Plastic Surgery, Astana Medical University, Nur-Sultan, Kazakhstan https://orcid.org/0000-0002-7251-0881
Medet Toleubayev Department of General and Plastic Surgery, Astana Medical University, Nur-Sultan, Kazakhstan; Department of Surgery, Multidisciplinary City Hospital, Nur-Sultan, Kazakhstan https://orcid.org/0000-0001-5119-6443

DOI:

https://doi.org/10.3889/oamjms.2021.6566

Keywords:

Acute subdural hematoma, Conventional delayed treatment, Nonsurgical treatment

Abstract

BACKGROUND: The preferred treatment method for acute subdural hematoma (aSDH) is surgical intervention.

AIM: We aimed to show that, regardless of the good results of surgical treatment, conventional delayed treatment might be very useful in some situations and might lead to chronicity of hematoma as well as reduction of surgical intervention scope and reduce risk of anesthesia. It might also give rise to spontaneous resorption of hematoma.

METHODS: In the period March 1, 2013–March 1, 2020, we retrospectively examined 215 aSDH patients. The basic result of the outcome analysis was evaluated on the basis of the Glasgow Outcome Scale (GOS) at discharge after 3-month and 6-month follow-up.

RESULTS: A total of 215 patients with aSDH and minor or moderate brain injury were examined, while applying conventional delayed treatment, the following results were obtained: large craniotomy was carried out in 123 patients (57.2%) on the 2nd–3rd day of observation, small craniotomy with drainage was applied in 29 patients (13.5%) and spontaneous resorption of subdural hematoma occurred in 63 patients (29.3%). The median score as per the Glasgow Coma Scale at admission to the hospital was 11.4.

CONCLUSION: This study showed that conventional delayed treatment applied in patients with aSDH and minor or moderate craniocerebral injury might lead to chronicity and resorption of aSDH. The outcomes as per the GOS scale also showed good data three and 6 months after hospitalization.

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References

Frontera JA, Egorova N, Moskowitz AJ. National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007. Crit Care Med. 2011;39(7):1619-25. https://doi.org/10.1097/ccm.0b013e3182186ed6 PMid:21423002 DOI: https://doi.org/10.1097/CCM.0b013e3182186ed6

Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T. Surgical management of traumatic acute subdural hematoma in adults: A review. Neurol Med Chir. 2014;54(11):887-94. https://doi.org/10.2176/nmc.cr.2014-0204 PMid:25367584 DOI: https://doi.org/10.2176/nmc.cr.2014-0204

Leitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I, et al. Outcome after severe brain trauma due to acute subdural hematoma. J Neurosurg. 2012;117(2):324-33. https://doi.org/10.3171/2012.4.jns111448 PMid:22631691 DOI: https://doi.org/10.3171/2012.4.JNS111448

Wilberger JE Jr., Harris M, Diamond DL. Acute subdural hematoma: Morbidity, mortality, and operative timing. J Neurosurg. 1991;74(2):212-8. https://doi.org/10.3171/ jns.1991.74.2.0212 PMid:1988590 DOI: https://doi.org/10.3171/jns.1991.74.2.0212

Howard MA, Gross AS, Dacey RG Jr., Winn HR. Acute subdural hematomas: An age dependent clinical entity. J Neurosurg. 1989;71(6):858-63. https://doi.org/10.3171/jns.1989.71.6.0858 PMid:2585078 DOI: https://doi.org/10.3171/jns.1989.71.6.0858

Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths-United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1-16. https://doi.org/10.15585/mmwr.ss6609a1 PMid:28301451 DOI: https://doi.org/10.15585/mmwr.ss6609a1

Gaonkar VB, Garg K, Agrawal D, Chandra PS, Kale SS. Risk Factors for progression of conservatively managed acute traumatic subdural hematoma: A systematic review and meta-analysis. World Neurosurg. 2021;146:332-41. https://doi.org/10.1016/j.wneu.2020.11.031 PMid:33197632 DOI: https://doi.org/10.1016/j.wneu.2020.11.031

Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB, Sheik-Ali S, et al. Craniotomy versus decompressive craniectomy for acute subdural hematoma: Systematic review and meta-analysis. World Neurosurg. 2017;101:677-85.e2. https://doi.org/10.1016/j.wneu.2017.03.024 PMid:28315797 DOI: https://doi.org/10.1016/j.wneu.2017.03.024

Lukasiewicz AM, Grant RA, Basques BA, Webb ML, Samuel AM, Grauer JN. Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: A study of the American college of surgeons national surgical quality improvement program. J Neurosurg. 2016;124(3):760-6. https://doi.org/10.3171/2015.2.jns142721 PMid:26315000 DOI: https://doi.org/10.3171/2015.2.JNS142721

Akbik OS, Starling RV, Gahramanov S, Zhu Y, Lewis J. Mortality and functional outcome in surgically evacuated acute subdural hematoma in elderly patients. World Neurosurg. 2019;126:e1235-41. https://doi.org/10.1016/j.wneu.2019.02.234 PMid:30885866 DOI: https://doi.org/10.1016/j.wneu.2019.02.234

Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58 Suppl 3:16-24; discussion Si-iv. https://doi.org/10.1227/01.neu.0000210364.29290.c9 PMid:16710968 DOI: https://doi.org/10.1227/01.NEU.0000210364.29290.C9

Kim BD, Hsu WK, de Oliveira GS Jr., Saha S, Kim JY. Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: An analysis of 4588 surgical cases. Spine (Phila Pa 1976). 2014;39(6):510-20. https://doi.org/10.1097/brs.0000000000000163 PMid:24365901 DOI: https://doi.org/10.1097/BRS.0000000000000163

Mathew P, Oluoch-Olunya DL, Condon BR, Bullock R. Acute subdural haematoma in the conscious patient: Outcome with initial non-operative management. Acta Neurochir (Wien). 1993;121(3-4):100-8. https://doi.org/10.1007/bf01809258 PMid:8512003 DOI: https://doi.org/10.1007/BF01809258

Choi YH, Han SR, Lee CH, Choi CY, Sohn MJ, Lee CH. Delayed burr hole surgery in patients with acute subdural hematoma: Clinical analysis. J Korean Neurosurg Soc. 2017;60(6):717-22. https://doi.org/10.3340/jkns.2017.0404.010 PMid:29142632 DOI: https://doi.org/10.3340/jkns.2017.0404.010

Croce MA, Dent DL, Menke PG, Robertson JT, Hinson MS, Young BH, et al. Acute subdural hematoma: Nonsurgical management of selected patients. J Trauma. 1994;36(6):820-6. https://doi.org/10.1097/00005373-199406000-00012 PMid:8015004 DOI: https://doi.org/10.1097/00005373-199406000-00012

Feliciano CE, de Jesus O. Conservative management outcomes of traumatic acute subdural hematomas. P R Health Sci J. 2008;27(3):220-3. PMid:18782966

Leung GK, Ng GK, Ho W, Hung KN, Yuen WK. Impact of a multidisciplinary trauma team on the outcome of acute subdural haematoma. Injury. 2012;43(9):1419-22. https://doi.org/10.1016/j.injury.2011.03.017 PMid:21474130 DOI: https://doi.org/10.1016/j.injury.2011.03.017