Abstract：
BACKGROUND: Acute subdural hematoma (ASDH) is a life-threatening condition, and hematoma removal is necessary as a lifesaving procedure when the intracranial pressure is highly elevated. However, whether decompressive craniectomy (DC) or conventional craniotomy (CC) is adequate remains unclear. Hinge craniotomy (HC) is a technique that provides expansion potential for decompression while retaining the bone flap. At our institution, HC is the first-line operation instead of DC for traumatic ASDH, and we present the surgical outcomes.
METHODS: From January 1, 2017, to December 31, 2022, 372 patients with traumatic ASDH were admitted to our institution, among whom 48 underwent hematoma evacuation during the acute phase. HC was performed in cases where brain swelling was observed intraoperatively. If brain swelling was not observed, CC was selected. DC was performed only when the brain was too swollen to allow replacement of the bone flap. We conducted a retrospective analysis of patient demographics, prognosis, and subsequent cranial procedures for each technique.
RESULTS: Of the 48 patients, 2 underwent DC, 23 underwent HC, and 23 underwent CC. The overall mortality rate was 20.8% (10/48) at discharge and 30.0% (12/40) at 6 months. The in-hospital mortality rates for DC, HC, and CC were 100% (2/2), 21.7% (5/23), and 13.0% (3/23), respectively. Primary brain injury was the cause of death in five patients whose brainstem function was lost immediately after surgery. No fatalities were attributed to the progression of postoperative brain herniation. In only one case, the cerebral contusion worsened after the initial surgery, leading to brain herniation and necessitating secondary DC.
CONCLUSIONS: The strategy of performing HC as the first-line operation for ASDH did not increase the mortality rate compared with past surgical reports and required secondary DC in only one case.
METHODS: From January 1, 2017, to December 31, 2022, 372 patients with traumatic ASDH were admitted to our institution, among whom 48 underwent hematoma evacuation during the acute phase. HC was performed in cases where brain swelling was observed intraoperatively. If brain swelling was not observed, CC was selected. DC was performed only when the brain was too swollen to allow replacement of the bone flap. We conducted a retrospective analysis of patient demographics, prognosis, and subsequent cranial procedures for each technique.
RESULTS: Of the 48 patients, 2 underwent DC, 23 underwent HC, and 23 underwent CC. The overall mortality rate was 20.8% (10/48) at discharge and 30.0% (12/40) at 6 months. The in-hospital mortality rates for DC, HC, and CC were 100% (2/2), 21.7% (5/23), and 13.0% (3/23), respectively. Primary brain injury was the cause of death in five patients whose brainstem function was lost immediately after surgery. No fatalities were attributed to the progression of postoperative brain herniation. In only one case, the cerebral contusion worsened after the initial surgery, leading to brain herniation and necessitating secondary DC.
CONCLUSIONS: The strategy of performing HC as the first-line operation for ASDH did not increase the mortality rate compared with past surgical reports and required secondary DC in only one case.
摘要：
背景：急性硬膜下血肿（ASDH）是一种危及生命的疾病，当颅内压高度升高时，血肿清除是必要的救命程序。然而,目前尚不清楚去骨瓣减压术(DC)或常规开颅术(CC)是否足够.铰链开颅术（HC）是一种在保留骨瓣的同时为减压提供扩张潜力的技术。在我们的机构，对于创伤性ASDH，HC是一线手术，而不是DC，我们介绍了手术结果。
方法：从2017年1月1日至2022年12月31日，我们机构收治了372例创伤性ASDH患者，其中48人在急性期接受了血肿清除术。在术中观察到脑肿胀的情况下进行HC。如果没有观察到脑肿胀，选择了CC。只有当大脑过于肿胀而无法更换骨瓣时，才进行DC。我们对患者的人口统计学进行了回顾性分析，预后,以及每种技术的后续颅骨手术。
结果：在48例患者中，2个接受DC，23人接受了HC，23人接受了CC。出院时总死亡率为20.8%(10/48),6个月时为30.0%(12/40)。DC的住院死亡率，HC,CC为100%(2/2)，21.7%（5/23），和13.0%（3/23），分别。原发性脑损伤是五名术后脑干功能立即丧失的患者的死亡原因。没有死亡归因于术后脑疝的进展。只有一种情况,初次手术后脑挫裂伤恶化,导致脑疝和需要继发性DC。
结论：与过去的手术报告相比，将HC作为ASDH的一线手术策略并没有增加死亡率，并且仅在一例中需要继发性DC。
方法：从2017年1月1日至2022年12月31日，我们机构收治了372例创伤性ASDH患者，其中48人在急性期接受了血肿清除术。在术中观察到脑肿胀的情况下进行HC。如果没有观察到脑肿胀，选择了CC。只有当大脑过于肿胀而无法更换骨瓣时，才进行DC。我们对患者的人口统计学进行了回顾性分析，预后,以及每种技术的后续颅骨手术。
结果：在48例患者中，2个接受DC，23人接受了HC，23人接受了CC。出院时总死亡率为20.8%(10/48),6个月时为30.0%(12/40)。DC的住院死亡率，HC,CC为100%(2/2)，21.7%（5/23），和13.0%（3/23），分别。原发性脑损伤是五名术后脑干功能立即丧失的患者的死亡原因。没有死亡归因于术后脑疝的进展。只有一种情况,初次手术后脑挫裂伤恶化,导致脑疝和需要继发性DC。
结论：与过去的手术报告相比，将HC作为ASDH的一线手术策略并没有增加死亡率，并且仅在一例中需要继发性DC。
