Decompressive Craniectomy vs. Craniotomy for Acute Subdural Hematoma

In a randomized trial of patients requiring evacuation of acute traumatic subdural hematoma via removal of a large bone flap, initial craniectomy did not improve outcomes compared with craniotomy.

Acute traumatic subdural hematoma (SDH) frequently requires surgical evacuation via craniotomy, wherein the bone flap is replaced during surgery, or craniectomy, wherein the bone flap is not replaced during the procedure. Patients with acute SDH are at risk for elevated intracranial pressure (ICP) due to traumatic cerebral edema and intraparenchymal hemorrhage and might benefit from decompressive craniectomy, but this procedure requires subsequent surgery to replace the bone flap. In this international trial, patients with acute SDH were randomized to craniotomy or craniectomy. The primary outcome was neurological status at 12 months, measured using the Extended Glasgow Outcome Scale.

A total of 228 patients were assigned to receive a cranio…

Reviewing Author

Craig A. Williamson, MD

Disclosures

Consultant/Advisory BoardNational Football League

RoyaltiesUpToDate, Inc.

Grant/Research SupportNational Institutes of Health

Editorial BoardsNeurocritical Care