Single burr hole surgery in the emergency room: surgical outcomes of patients with severe acute subdural hematomas

DOI 3 Citations 9 References
  • Yoshida Yuki
    Department of Critical Care Medicine, School of Medicine, Iwate Medical University
  • Kuroda Kiyoshi
    Department of Critical Care Medicine, School of Medicine, Iwate Medical University
  • Wada Tsukasa
    Department of Critical Care Medicine, School of Medicine, Iwate Medical University
  • Okuguchi Taku
    Department of Critical Care Medicine, School of Medicine, Iwate Medical University
  • Endo Shigeatsu
    Department of Critical Care Medicine, School of Medicine, Iwate Medical University
  • Ogawa Akira
    Department of Neurosurgery, School of Medicine, Iwate Medical University

Bibliographic Information

Other Title
  • 救急外来における緊急穿頭術―重症急性硬膜下血腫の治療成績―
  • Surgical Outcomes of Patients with Severe Acute Subdural Hematomas
  • 重症急性硬膜下血腫の治療成績

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Abstract

The removal of hematomas using single burr hole emergent surgery was performed in 52 patients between January 1996 and April 2002. The main symptoms of the patients were a traumatic acute subdural hematoma (ASDH) at the time of the initial CT observation, a shift in the midline structures of 10mm or more, and/or a Glasgow coma scale (GCS) score of 10 or less. Cerebral herniation with pupillary abnormalities were observed in 42 out of 52 patients with ASDH upon their arrival at the hospital. The average hematoma extraction rate using only a single burr hole was 69%. The extraction rate was particularly high for patients exhibiting mixed low density hematoma areas on their CT images. Improvement in pupillary findings or in the level of consciousness was observed in 36 patients immediately after hematoma extraction using single burr hole surgery. Postoperative control of intracranial pressure (ICP) was successfully performed in 13 patients. The overall clinical outcomes consisted of good recovery (GR) in 6, moderate disability (MD) in 6, severe disability (SD) in 4, persistent vegetative state (PVS) in 4 and death (D) in 32 patients. The clinical outcomes of patients who underwent single burr hole surgery consisted of GR in 6, MD in 4, SD in 1 and D in 22 patients. Furthermore, an additional craniotomy resulted in MD in 2, SD in 3, PVS in 4 and D in 10 patients. Single burr hole surgery is a quick and effective method for extracting ASDH, and favorable results can be expected even in patients with serious head injuries. Active single burr hole surgery in the emergency room is recommended for severe cases of ASDH.

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