Clinical characteristics and limitations of therapy for lethal acute subdural hematoma. Cases in which acute brain swelling is detected during decompressive craniectomy.:Cases in Which Acute Brain Swelling is Detected during Decompressive Craniectomy

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Acute subdural hematoma (ASDH) is one of the most lethal neurosurgical problems. We investigated the clinical characteristics and limits of treatment for ASDH in which acute brain swelling is detected during decompressive craniectomy. Between 1994 and 1995 we encountered 13 patients with ASDH in whom acute brain swelling was detected during decompressive craniectomy. After operation, mild hypothermia and barbiturate therapy were performed whenever possible. Only one of the 13 patients (a 2-year-old girl) achieved a good recovery, and the other 12 died. The Glasgow Coma Scale score on admission ranged from 3 to 8 (3-4 in 7 patients and 5-8 in 6 patients). Twelve of the 13 patients exhibited abnormal pupillary findings on admission (4 had bilateral fully dilated pupils and 8 had anisocoria). On initial computed tomography, 10 patients had associated cerebral contusion or traumatic subarachnoid hemorrhage. In 10 patients, the interpeduncular cistern was invisible and the basal cistern was filled with blood from a traumatic subarachnoid hemorrhage in 3 patients. The mean interval from injury to operation was 2 hours 41min (range 28min to 4 hours 56min). Obliteration of the interpeduncular cistern was found to be closely correlated with a poor outcome.
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