The Surgical Outcome of Traumatic Extraaxial Hematomas Causing Brain Herniation
AIM: The aim of this study was to assess the surgical outcome and the prognostic importance of clinical and radiological data of
patients operated emergently for an extraaxial hematoma causing brain herniation.
MATERIAL and METHODS: This retrospective study comprised 108 adult patients who were operated due to herniated traumatic
extraaxial hematomas from January 2000 to January 2013.
RESULTS: Of 108 patients, 63 patients (58.3%) were diagnosed as subdural hematoma (SDH), and 45 patients (41.7%) as epidural
hematoma (EDH). An unfavorable outcome was significantly increased for patients who were diagnosed as SDH (90.4%) compared
with EDH patients (33.3%). Mortality rate for herniated SDH patients was 65.1%, and 26.6% for herniated EDH patients. High mortality
and unfavorable outcome ratios were associated with Glasgow Coma Scale scores at admission, mean postoperative intracranial
pressure (ICP) values, type of the brain herniation, interval from the time of trauma to the time of hematoma decompression, the
duration of the brain herniation, intraoperative acute brain swelling, hematoma volume and thickness, degree of the midline shift
and the obliteration of the basal cisterns.
CONCLUSION: Our data showed that, postoperative ICP values were one most important predictor of the mortality. We recommended
postoperative ICP monitoring for all patients presenting with the brain herniation due to traumatic extraaxial hematoma.