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.
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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
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