Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 2/2020

23.01.2019 | Original Article

Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects

verfasst von: Jan Chrastina, Čeněk Šilar, Tomáš Zeman, Michal Svoboda, Jan Krajsa, Barbora Musilová, Zdeněk Novák

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome.

Methods

Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery—trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied.

Results

Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients.

Conclusions

Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.
Literatur
1.
Zurück zum Zitat Kwinta BM, Krzyżewski RM, Kliś KM, Donicz P, Gackowska M, Polak J, Stachura K, Moskała M. Emergency reoperations in cranial neurosurgery. World Neurosurg. 2017;105:749–4.CrossRef Kwinta BM, Krzyżewski RM, Kliś KM, Donicz P, Gackowska M, Polak J, Stachura K, Moskała M. Emergency reoperations in cranial neurosurgery. World Neurosurg. 2017;105:749–4.CrossRef
2.
Zurück zum Zitat Desai VR, Grossman R, Sparrow H. Incidence of intracranial hemorrhage after a cranial operation. Cureus. 2016;8:e616.PubMedPubMedCentral Desai VR, Grossman R, Sparrow H. Incidence of intracranial hemorrhage after a cranial operation. Cureus. 2016;8:e616.PubMedPubMedCentral
3.
Zurück zum Zitat Chen SH, Chen Y, Fang WK, Huang DW, Huang KC, Tseng SH. Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma. 2011;71:1632–6.CrossRef Chen SH, Chen Y, Fang WK, Huang DW, Huang KC, Tseng SH. Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma. 2011;71:1632–6.CrossRef
4.
Zurück zum Zitat Lenzi J, Caporlingua F, Caporlingua A, Anichini G, Nardone A, Passacantilli E, Santoro A. Relevancy of positive trends in mortality and functional recovery after surgical treatment of acute subdural hematomas. Our 10-year experience. Br J Neurosurg. 2017;31:78–83.CrossRef Lenzi J, Caporlingua F, Caporlingua A, Anichini G, Nardone A, Passacantilli E, Santoro A. Relevancy of positive trends in mortality and functional recovery after surgical treatment of acute subdural hematomas. Our 10-year experience. Br J Neurosurg. 2017;31:78–83.CrossRef
5.
Zurück zum Zitat Servadei F, Nasi MT, Giuliani G, Cremonin AM, Cenni P, Zappi D, Taylor GS. CT prognostic factors in acute subdural hematomas. The value of the worst CT scan. Br J Neurosurg. 2000;14:110–6.CrossRef Servadei F, Nasi MT, Giuliani G, Cremonin AM, Cenni P, Zappi D, Taylor GS. CT prognostic factors in acute subdural hematomas. The value of the worst CT scan. Br J Neurosurg. 2000;14:110–6.CrossRef
6.
Zurück zum Zitat Al-Mufti F, Mayer SA. Neurocritical care of acute subdural hemorrhage. Neurosurg Clin N Am. 2017;28(2):267–78.CrossRef Al-Mufti F, Mayer SA. Neurocritical care of acute subdural hemorrhage. Neurosurg Clin N Am. 2017;28(2):267–78.CrossRef
7.
Zurück zum Zitat Han H, Koh EJ, Choi H, Kim BC, Yang SY, Cho KT. The effect of preoperative antiplatelet therapy on hemorrhagic complications after decompressive craniectomy in patients with traumatic brain injury. Korean J Neurotrauma. 2016;12:61–6.CrossRef Han H, Koh EJ, Choi H, Kim BC, Yang SY, Cho KT. The effect of preoperative antiplatelet therapy on hemorrhagic complications after decompressive craniectomy in patients with traumatic brain injury. Korean J Neurotrauma. 2016;12:61–6.CrossRef
8.
Zurück zum Zitat Su TM, Lee TH, Chen WF, Lee TC, Cheng CH. Contralateral acute epidural hematoma after decompressive surgery of acute subdural hematoma: clinical features and outcome. J Trauma. 2008;65:1298–302.CrossRef Su TM, Lee TH, Chen WF, Lee TC, Cheng CH. Contralateral acute epidural hematoma after decompressive surgery of acute subdural hematoma: clinical features and outcome. J Trauma. 2008;65:1298–302.CrossRef
9.
Zurück zum Zitat Tomycz ND, Germanwala AV, Walter KA. Contralateral acute subdural haematoma after surgical evacuation of acute subdural hematoma. J Trauma. 2010;68:E2–11.CrossRef Tomycz ND, Germanwala AV, Walter KA. Contralateral acute subdural haematoma after surgical evacuation of acute subdural hematoma. J Trauma. 2010;68:E2–11.CrossRef
10.
Zurück zum Zitat Matsuno A, Katayama H, Wada H, Morikawa K, Tahala K, Tahala H, Murazaki M, Fuke E, Nagashima T. Significance of consecutive bilateral surgeries for patients with acute subdural haematoma who developed contralateral acute epi - or subdural haematoma. Surg Neurol. 2003;60:23–30.CrossRef Matsuno A, Katayama H, Wada H, Morikawa K, Tahala K, Tahala H, Murazaki M, Fuke E, Nagashima T. Significance of consecutive bilateral surgeries for patients with acute subdural haematoma who developed contralateral acute epi - or subdural haematoma. Surg Neurol. 2003;60:23–30.CrossRef
11.
Zurück zum Zitat Flordelís Lasierra JL, García Fuentes C, Toral Vázquez D, Chico Fernández M, Bermejo Aznárez S. Alted López E. Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury. Eur J Trauma Emerg Surg. 2013;39:277–83.CrossRef Flordelís Lasierra JL, García Fuentes C, Toral Vázquez D, Chico Fernández M, Bermejo Aznárez S. Alted López E. Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury. Eur J Trauma Emerg Surg. 2013;39:277–83.CrossRef
12.
Zurück zum Zitat Shen J, Fan Z, Ji T, Pan J, Zhou Y, Zhan R. Contralateral acute subdural haematoma following traumatic acute subdural hematoma evacuation. Neurol Med Chir (Tokyo). 2013;53:221–3.CrossRef Shen J, Fan Z, Ji T, Pan J, Zhou Y, Zhan R. Contralateral acute subdural haematoma following traumatic acute subdural hematoma evacuation. Neurol Med Chir (Tokyo). 2013;53:221–3.CrossRef
13.
Zurück zum Zitat Kwon H, Choi KS, Yi HJ, Chun HJ, Lee YJ, Kim DW. Risk factors of delayed surgical intervention after conservatively treated acute traumatic subdural Hematoma. J Korean Neurosurg Soc. 2017;60:723–9.CrossRef Kwon H, Choi KS, Yi HJ, Chun HJ, Lee YJ, Kim DW. Risk factors of delayed surgical intervention after conservatively treated acute traumatic subdural Hematoma. J Korean Neurosurg Soc. 2017;60:723–9.CrossRef
14.
Zurück zum Zitat Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, Gravori T, Obukhov D, McBride DQ, Martin NA. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96:109–16.CrossRef Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, Gravori T, Obukhov D, McBride DQ, Martin NA. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96:109–16.CrossRef
15.
Zurück zum Zitat Panczykowski DM, Okonkwo DO. Premorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas. J Neurosurg. 2011;114:47–52.CrossRef Panczykowski DM, Okonkwo DO. Premorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas. J Neurosurg. 2011;114:47–52.CrossRef
16.
Zurück zum Zitat Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery. 1994;35:1061–4.CrossRef Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery. 1994;35:1061–4.CrossRef
17.
Zurück zum Zitat Fabbri A, Servadei BF, Marchesini G, Stein SC, Vandelli A. Predicting intracranial lesion by antiplatelet agents in subjects with mild head injury. J Neurol Neurosurg Psychiatry. 2010;81:1275–9.CrossRef Fabbri A, Servadei BF, Marchesini G, Stein SC, Vandelli A. Predicting intracranial lesion by antiplatelet agents in subjects with mild head injury. J Neurol Neurosurg Psychiatry. 2010;81:1275–9.CrossRef
18.
Zurück zum Zitat Chrastina J, Hrabovský D, Zvarová M, Ríha I, Novák Z. [The effect of anticoagulation and anti-platelet treatment on the extent, development and prognosis of acute craniocerebral injury] [Article in Czech]. Acta Chir Orthop Traumatol Cech. 2014;81:77–84.PubMed Chrastina J, Hrabovský D, Zvarová M, Ríha I, Novák Z. [The effect of anticoagulation and anti-platelet treatment on the extent, development and prognosis of acute craniocerebral injury] [Article in Czech]. Acta Chir Orthop Traumatol Cech. 2014;81:77–84.PubMed
19.
Zurück zum Zitat Moussa WMM, Khedr WM, Elwany AH. Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study. Neurosurg Rev. 2018;41:483–8.CrossRef Moussa WMM, Khedr WM, Elwany AH. Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study. Neurosurg Rev. 2018;41:483–8.CrossRef
20.
Zurück zum Zitat Bartels RH, Meijer FJ, van der Hoeven H, Edwards M, Prokop M. Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality. BMC Neurol. 2015;15:220.CrossRef Bartels RH, Meijer FJ, van der Hoeven H, Edwards M, Prokop M. Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality. BMC Neurol. 2015;15:220.CrossRef
22.
Zurück zum Zitat Lu T, Guan J, An C. Preoperative trepanation and drainage for acute subdural hematoma: Two case reports. Exp Ther Med. 2015;10(1):225–30.CrossRef Lu T, Guan J, An C. Preoperative trepanation and drainage for acute subdural hematoma: Two case reports. Exp Ther Med. 2015;10(1):225–30.CrossRef
23.
Zurück zum Zitat Endo H, Fukawa O, Mashiyama S, Kawase M. [Single burr hole surgery for acute spontaneous subdural hematoma in the aged: patient reports of three cases]. No Shinkei Geka. 2004;32(3):271–6.PubMed Endo H, Fukawa O, Mashiyama S, Kawase M. [Single burr hole surgery for acute spontaneous subdural hematoma in the aged: patient reports of three cases]. No Shinkei Geka. 2004;32(3):271–6.PubMed
24.
Zurück zum Zitat Di Rienzo A, Iacoangeli M, Almaro L, Colasanti R, Somma LGMD, Nocchi N, Gladi M, Scerrati M. Mini-craniotomy under local anesthesia to treat acute subdural haematoma in deteriorating elderly patient. J Neurol Surg A Centr Eur Neurorosurg. 2017;78:535–40.CrossRef Di Rienzo A, Iacoangeli M, Almaro L, Colasanti R, Somma LGMD, Nocchi N, Gladi M, Scerrati M. Mini-craniotomy under local anesthesia to treat acute subdural haematoma in deteriorating elderly patient. J Neurol Surg A Centr Eur Neurorosurg. 2017;78:535–40.CrossRef
25.
Zurück zum Zitat Yokosuka K, Uno M, Matsumura K, Takai H, Hagino H, Matsushita N, Matsubara S. Endoscopic haematoma evacuation for acute and subacute subdural hematoma in elderly patient. J Neurosurg. 2015;123:1065–9.CrossRef Yokosuka K, Uno M, Matsumura K, Takai H, Hagino H, Matsushita N, Matsubara S. Endoscopic haematoma evacuation for acute and subacute subdural hematoma in elderly patient. J Neurosurg. 2015;123:1065–9.CrossRef
26.
Zurück zum Zitat Li X, von Holst H, Kleiven S. Decompressive craniectomy causes a significant strain increase in axonal fiber tracts. J Clin Neurosci. 2013;30:509–13.CrossRef Li X, von Holst H, Kleiven S. Decompressive craniectomy causes a significant strain increase in axonal fiber tracts. J Clin Neurosci. 2013;30:509–13.CrossRef
27.
Zurück zum Zitat Vilcinis R, Bunevicius A, Tamasauskas A. The association of surgical method with outcomes of acute subdural hematoma patients: experience with 643 consecutive patients. World Neurosurg. 2017;101:335–42.CrossRef Vilcinis R, Bunevicius A, Tamasauskas A. The association of surgical method with outcomes of acute subdural hematoma patients: experience with 643 consecutive patients. World Neurosurg. 2017;101:335–42.CrossRef
28.
Zurück zum Zitat Tsermoulas G, Shah O, Wijesinghe HE, Silva AH, Ramalingam SK, Belli A. Surgery for acute subdural hematoma: replace or remove the bone flap? World Neurosurg. 2016;88:569–75.CrossRef Tsermoulas G, Shah O, Wijesinghe HE, Silva AH, Ramalingam SK, Belli A. Surgery for acute subdural hematoma: replace or remove the bone flap? World Neurosurg. 2016;88:569–75.CrossRef
29.
Zurück zum Zitat Kim H, Suh SJ, Kang HJ, Lee MS, Lee YS, Lee JH, Kang DG. Predictable values of decompressive craniectomy in patients with acute subdural hematoma: comparison between decompressive craniectomy after craniotomy group and craniotomy only group. Korean J Neurotrauma. 2018;14(1):14–9.CrossRef Kim H, Suh SJ, Kang HJ, Lee MS, Lee YS, Lee JH, Kang DG. Predictable values of decompressive craniectomy in patients with acute subdural hematoma: comparison between decompressive craniectomy after craniotomy group and craniotomy only group. Korean J Neurotrauma. 2018;14(1):14–9.CrossRef
30.
Zurück zum Zitat Zhao HX, Liao Y, Xu D, Wang QP, Gan Q, You C, Yang CH. The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions. BMC Surg. 2015;15:111.CrossRef Zhao HX, Liao Y, Xu D, Wang QP, Gan Q, You C, Yang CH. The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions. BMC Surg. 2015;15:111.CrossRef
Metadaten
Titel
Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects
verfasst von
Jan Chrastina
Čeněk Šilar
Tomáš Zeman
Michal Svoboda
Jan Krajsa
Barbora Musilová
Zdeněk Novák
Publikationsdatum
23.01.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 2/2020
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01077-6

Weitere Artikel der Ausgabe 2/2020

European Journal of Trauma and Emergency Surgery 2/2020 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.