Journal of Korean Society of Geriatric Neurosurgery 2013;9(2):97-102.
Published online December 30, 2013.
Factors Associated with Delayed Traumatic Intracerebral Hemorrhge after Decompressive Craniectomy in Old Patients with Acute Subdural Hematoma
Dong Hee Kim , Sun Ki Hong , Chul Hu , Jin Su Pyen , Kum Whang , Sung Min Cho , Jong Yeon Kim , Ji Woong Oh
Department of Neurosurgery, Yonsei University Wonju College of Medicine, Gangwon, Korea
노인 급성 경막하 출혈 환자에서 두개골 감압술 후에 발생하는 지연성 외상성 뇌실질내 출혈과 연관있는 인자들
김동희ㆍ홍순기ㆍ허 철ㆍ변진수ㆍ황 금ㆍ조성민ㆍ김종연ㆍ오지웅
연세대학교 원주의과대학 신경외과학교실
Abstract
Objective
Decompressive craniectomy (DC) has been the most chosen operative technique for decreasing the intracranial pressure in patients with acute subdural hematoma. Yet, DC has some severe complications such as delayed traumatic intracerebral hemorrhage (DT-ICH). This study investigated the variable factors which may cause DT-ICH post-operatively.
Methods
We retrospectively reviewed 72 acute SDH patients above 60 year-old whom underwent DC at our institution between January 2010 and January 2012. All patients were analyzed based on the information acquired from the pre-operative clinical factors (gender, past history, cause of injury, aspartate aminotransferase (AST) / alanine transaminase (ALT), prothrombin time (PT), international normalized ratio (INR), platelet count, presence of contusional hemorrhage at preoperative computed tomography (CT), thickness of hematoma, degree of midline shift and, compression ratio (midline shift/hematoma thickness)). Immediate post-operative CT scan was carried out in all patients. Then, the relationship between each parameter and presence of DT-ICH after DC was analyzed statistically.
Results
Out of 72 SDH elderly patients, DT-ICH occurred in 26 patients (36%) while the rest of 46 patients (64%) had no further hemorrhagic event. Of many variable factors to cause DT-ICH, male, low platelet count, INR prolongation, PT prolongation, presence of contusional hemorrhage, hematoma thickness and compression ratio showed a statistically significance in univariate analysis (p<0.05). Whereas in multivariate analysis, low platelet count, INR prolongation, thicker hematoma and low compression ratio demonstrated a statistically significance (p<0.05).
Conclusion
According to our study, patients with low compression ratio had a higher tendency of DT-ICH after DC. This information can be crucial in predicting the possibility of DT-ICH in higher risk elderly patients.
Key Words: Decompressive craniectomyㆍAcute Subdural HematomaㆍDelayed traumatic intracerebral hemorrhage


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