Fumihito Yamamoto

Treatment of acute subdural hematoma with a low GCS score

In order to clarify the present problems in the treatment of acute subdural hematoma with low GCS score (5 or less), we studied the difference of the outcomes from two different surgical treatments for these patients. The present series included 30 patients who had GCS scores of 3, 4 or 5, and they were divided into two groups: 16 in DH group who had decompressive hemicraniectomy and 14 in HITT group who had hematoma irrigation with trephination therapy. The mean age of the patients was 47 years. They all had an intensive medical management including barbiturate therapy under intracranial pressure (ICP) monitoring after the operation. Time course of ICP after operation was classified as controlled, high but reduced and uncontrollable, based on the ICP level of 30 mmHg. The outcomes of the patients were determined by use of Glasgow outcome scale and classified into good, poor and dead. In these patients, the outcome was good in 13.3%, poor in 23.3% and dead in 63.4%. There was no survived case in those with GCS score of 3. The mortality rate in older patients over 60 years was high as 81.8%. ICP was well controlled in 2 patients (12.4%) in DH group. But there is no such case in HITT group. Uncontrollable ICP was more frequently seen in HITT group than in DH group. The patients showed different outcomes in the two types of treatment. Good outcome was found in 18.7% and the mortality rate was 56.3% in DH group. On the other hand, only one patient (7.1%) showed good outcome and the mortality rate of 71.4% in HITT group.(ABSTRACT TRUNCATED AT 250 WORDS)