Journal of Korean Society of Geriatric Neurosurgery 2010;6(1):42-45.
Published online June 30, 2010.
Feasibility of Multiple Dural Fenestration in Patients with Acute Subdural Hematomas with Severe Brain Contusion
Se-Whan Ahn , Hyun-Woo Kim , Jung-Ho Ko , Ho-Gyun Ha , Chul-Ku Jung
Department of Neurosurgery, Konyang University Colloege of Medicine, Daejeon, Korea
The authors adopted a relatively new surgical technique introduced by Joseph N. Guilburd et al. which uses multiple dural fenestration (MFD) in 5 cases for decompression of the intracranial hematomas and ponder the feasibility for the management of such lesion by this surgical technique. Mortality of acute subdural hematomas (ASDHs) is more than 50% and the prognosis is very poor resulting in permanent severe neurological deficits despite advances in surgical technique. So far, craniectomy (or craniotomy) with hematoma removal after a large dural incision was the preferred surgical treatment for ASDHs but the advantage was controversial at best, especiallyin patients with large amount of ASDHs, severe midline shifts, or severe brain parenchymal injury.
5 patients with severe brain contusion and ASDH were managed by MFD between May, 2007 till March, 2010. Authors compared patients’ preoperative and postoperative Glasgow coma scale (GCS), pupil size, light reflex and performed brain computed tomography (B-CT) to check depth of hematoma and midline shifting.
Postoperative GCS score was 7±2.00 SD and there was no significant difference compared to preoperative GCS (6.8±2.95 SD) relatively. And among 5 patients, 4 patients underwent follow up B-CT. On follow up B-CT the average of midline shifting decreased from 12.1±3.47 mm SD to 9.5±4.87 mm SD and the average of maximal depth of hematoma also decreased from 14.7±3.51 mm SD to 8.1 ±4.56 mm SD. All 5 patients expired. 4 patients died of brain herniation and 1 patient’s cause of death was septic shock due to pseudomembraneous colitis. And there was no case of wound infection, CSF leakage or CNS infection.
Through 5 cases the authors concluded that MFD is a useful surgical option in the treatment of patients with ASDHs with severe brain contusion.
Key Words: Multiple fenestration of duraㆍAcute subdural hematomasㆍCerebral contusion

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