A new protocol for severe acute subdural hematoma with cerebral contusion. Intentionally delayed decompressive craniectomy.:Intentionally Delayed Decompressive Craniectomy
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Early decompressive craniectomy has been recommended as treatment for acute subdural hematoma (ASDH) complicated with cerebral contusion. However, it has frequently entailed acute brain swelling and delayed traumatic intracerebral hematoma (DTICH). Therefore, in addition to early decompressive craniectomy, we devised a new protocol consisting of emergency evacuation of the subdural hematoma via a single burr hole, intracranial pressure monitoring with external ventricular drainage and medical treatment (barbiturate therapy, etc). However when intracranial hypertension developed despite the new management, decompressive craniectomy was done. To compare prognostic and hemostatic data between patients treated with early decompressive craniectomy and patients treated with the new protocol, we assigned 23 patients with severe ASDH and cerebral contusion (GCS Score 8 or less) to the group treated with early decompressive craniectomy and craniotomy (group I) or the group treated with the new protocol (group II). The mean GCS score on admission did not differ between group I (4.5±1.3) and group II (4.2±1.2). Nevertheless, the development rate of DTICH was 6 (60%) of 10 patients (group II) compared with 11 (84.6%) of 13 patients (group I). In addition, group II had a better outcome than group I (66.7% favorable outcome, good recovery and moderate disability, in group II). Hemostatic data were comparable in the cerebral contusion patients with and without DTICH, but an α2 plasmin inhibitor, which is the main inhibitor of the fibrinolytic system, was lower in patients with DTICH than in those without DTICH. These results suggest that our new protocol appears to be safer and more useful for the management of severe ASDH with cerebral contusion than the traditional method.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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