Comparison of Efficacy of Decompressive Craniectomy By Multiple Dural Stabs Versus Open Dural Flap For The Evacuation of Acute Subdural Hematoma
DOI:
https://doi.org/10.51253/pafmj.v74i2.3828Keywords:
Acute subdural hematoma, Decompressive craniectomy, Multiple dural stabs, Open dural flapAbstract
Objective: to study the functional outcome of the subjects of acute subdural hematoma subjected to decompressive craniectomy by multiple dural stabs versus open dural flap using the Glasgow outcome score.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Neurosurgery Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2019.
Methodology: Eighty patients with acute subdural hematoma were recruited for this study and equally divided into two groups. In Group-A, decompressive craniectomy was performed using multiple dural stabs, whereas patients of Group-B had open dural flap craniectomy.
Results: The mean age of the patients was 30.9±9.98 years in Group-A and 31.2±8.9 years in Group-B. A comparison of functional outcomes based on the Glasgow Outcome Score on the 14th day showed that 62.5% of patients had an unfavourable outcome in Group-A, while 90.60% had the same in Group-B. On the other hand, 37.7% of Group-A patients had a favourable outcome, whereas 9.6% had a favourable recovery in Group-B (p-value : 0.001).
Conclusion: Acute subdural hematoma treated with multiple dural stabs technique of decompressive craniectomy has a better outcome as compared to open dural flap technique in terms of functional status of the patient.
Downloads
Metrics
References
Khan B, Khan Afridi EA, Khan B, Khan SA, Aurangzeb A, Khan AA, et al. Decompressive Craniectomy for Acute Subdural Haematoma with Expansile Duraplasty versus Dural-Slits. J Ayub Med Coll Abbottabad 2016 ; 28(2): 285-288.
Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009 ; 26(6): E9.
https://doi.org/10.3171/2009.3.focus0962
Godil SS, Shamim MS, Enam SA, Qidwai U, Qadeer M, Sobani ZA. Cranial reconstruction after decompressive craniectomy: prediction of complications using fuzzy logic. J Craniofac Surg 2011 ; 22(4): 1307-1311.
https://doi.org/10.1097/SCS.0b013e31821c6d37
Honeybul S, Ho KM. Long-term complications of decompressive craniectomy for head injury. J Neurotrauma 2011 ; 28(6): 929-35. https://doi.org/10.1089/neu.2010.1612
Honeybul S, Morrison DA, Ho K, Wiggins A, Janzen C, Kruger K. Complications and consent following decompressive craniectomy: an illustrative case study. Brain Inj 2013; 27(13-14): 1732-1736. https://doi.org/10.3109/02699052.2013.830194
Kim H, Suh SJ, Kang HJ, Lee MS, Lee YS, Lee JH, et al. 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): 14-19. https://doi.org/10.13004/kjnt.2018.14.1.14
Kwon YS, Yang KH, Lee YH. Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome. Korean J Neurotrauma 2016 ; 12(1): 22-27. https://doi.org/10.13004/kjnt.2016.12.1.22
Kalayci M, Aktunç E, Gül S, Hanci V, Edebali N, Cagavi F, et al. Decompressive craniectomy for acute subdural haematoma: anoverview of current prognostic factors and a discussion about some novel prognostic parametres. J Pak Med Assoc 2013 ; 63(1): 38-49.
Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB, Sheik-Ali S, et al. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis. World Neurosurg 2017 ; 101: 677-685.e2. https://doi.org/10.1016/j.wneu.2017.03.024
Honeybul S, Ho KM. The current role of decompressive craniectomy in the management of neurological emergencies. Brain Inj 2013; 27(9): 979-991
. https://doi.org/10.3109/02699052.2013.794974
Honeybul S, Ho KM, Gillett GR. Reconsidering the role of decompressive craniectomy for neurological emergencies. J Crit Care 2017 ; 39: 185-189.
https://doi.org/10.1016/j.jcrc.2017.03.006
van Middelaar T, Nederkoorn PJ, van der Worp HB, Stam J, Richard E. Quality of life after surgical decompression for space-occupying middle cerebral artery infarction: systematic review. Int J Stroke 2015; 10(2): 170-176.
https://doi.org/10.1111/ijs.12329
Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg 2016 ; 11(4): 330-342.
https://doi.org/10.4103/1793-5482.145102
Lee HS, Song SW, Chun YI, Choe WJ, Cho J, Moon CT, et al. Complications Following Burr Hole Craniostomy and Closed-System Drainage for Subdural Lesions. Korean J Neurotrauma 2018 ; 14(2): 68-75. https://doi.org/10.13004/kjnt.2018.14.2.68
Lee KS. How to Treat Chronic Subdural Hematoma? Past and Now. J Korean Neurosurg Soc 2019 ; 62(2): 144-152. https://doi.org/10.3340/jkns.2018.0156
Khan ZM, Islam M, Khokhar TI, Majid HA. Recurrence of CSHD after single burr-hole evacuation and closed drainage system versus double burr hole evacuation and closed drainage system. Pak J Neurol Surg 2018; (22)4: 166-172.
Khan HU, Atif K, Boghsani GT. Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan. Pak J Med Sci 2019 ; 35(4): 963-968. https://doi.org/10.12669/pjms.35.4.543
Taussky P, Fandino J, Landolt H. Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg 2008 ; 22(2): 279-282. https://doi.org/10.1080/02688690701818885
Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB, Sheik-Ali S, et al. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis. World Neurosurg 2017 ; 101: 677-685.e2. https://doi.org/10.1016/j.wneu.2017.03.024. 28315797
Downloads
Published
How to Cite
Issue
Section
