Comparative study between the outcome of decompressive craniotomy versus craniectomy in the management of acute subdural hematoma

Abstract

BackgroundAcute Subdural hematoma is a very crucial entity in traumatic brain injury, presented with disabling morbid complications and a high mortality rate; therefore, it is a massive socio-economic burden, leading to either direct or secondary brain injury, as hypoxia.Aim and objectivesComparative study between decompressive craniotomy (DC) and craniectomy in the management of acute subdural and their consequences. Assessing the most effective management protocol for ASDH with the least morbidity, short hospital’ stay and avoidance of re-operation.MethodThe study design is a prospective comparative randomized study, conducted on 30 patients with ASDH operated and managed starting December 2019 inclusive April 2021 at the Neurosurgery Department Cairo University Hospitals. They were divided equally into two groups: 15 had decompressive craniectomy and another 15 cases were operated upon with craniotomy. All patients were diagnosed with traumatic ASDH.ResultsThe mean GCS pre-operative in DC was (9.4) mean with a range from (6 to 13) and the post-operative mean was (11.13) with a range from (4 to 15) compared to the results in the craniotomy group; the pre-operative mean was (9.6) with a range from (6 to 10) and the post-operative GCS mean (11.53) ranging from (6 to 14) that had a P value of 0.69.ConclusionThere is no statistical significance in comparing decompressive craniectomy and craniotomy in dealing with ASDH, yet early time of surgical evacuation and duroplasty have shown to have good prognostic factors.