Aim:to evaluate of the impact of primary decompressive craniectomy [DC] on the functional outcome in patients with post traumatic acute subdural hematoma [SDH].
Material and Methods:A retrospective cohort analysis of 92 patients with post traumatic acute SDH who underwent primary DC and evacuation of SDH. The primary outcome variable is Glasgow outcome scale at 6 months follow up, while exposure variables are demographic data [age and gender], initial Glasgow coma scale, Marshall Classification Score of traumatic brain injury, midline shift, side of the lesion, surgery related complications and time of cranioplasty.
Results:Out of the 92 patients in this study, 89.1% were males and the mean age was 30.2 ± 14.4 years. At admission, the mean Glasgow Coma Scale [GCS] was 5.8 ± 2 and mean Marshall score was 4.7 ± 0.7, while the average midline shift was 8.8 ± 3.5 mm . Right decompressive craniectomy was performed in 46 [50%] patients, while in 2 [2.1%] cases bi-frontal craniectomy was performed and left decompressive craniectomy was performed in 44 [47.8%] patients. Mortality was reported in 38 patients [41.3%] and poor outcome was reported in 24 patients [26.1%], while 30 patients [32.6%] showed good outcome. During the follow up period, cranioplasty for restoration of the bone defect was completed in 52 patients.
Conclusion:Primary decompressive craniectomy after STBI for post-traumatic acute subdural hematoma improved the favorable outcome whenever the initial GCS >4 among adult patients.