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Chronic extradural hematoma: Report on 12 cases
S74
Head Injury - Outcome after Head Injury
patients (60.6%) died, two (6%) became vegetative, five (15.1%) developed a severedisabilityand six (18.t%) made a functional recovery. Patientsadmitted morethan 1 hour after trauma,those showingpupillary changes and those with shift, evacuated mass lesion or nonevacuated mass lesionon CT scanscorrelated with an unfavourable outcome.Only one of four patientswho underwent surgeryfor TBGHssurvived. Conclusion: Mortalitydue to TBGHs was 60.6%, higherthan overall mortality rate for SHls but the difference was not significant. TBGHs are dynamic lesions that tend to enlarge. Patients with hematoma volume greater than 25 cc had the worst prognosis and perhaps more aggressive surgical treatment shouldbe considered in them.
I P-2-173!
Delayed epidural hematomas
Delayed epidural hematoma (DEH) is rare clinical entity (about 40 cases reviewed from literature) which is characterized by clinicalpresentation three or more days after trauma. We present two young patients who developed DEH 7-12 days after primarytrauma, caused by trafficaccident. Thefirst patient, 11 years old boy,was somnolent immediately after trauma, and cerebral contusion was verified by computed tomography (CT).The patient recovered very well aftermedicamentous therapy, but after12 daysdeteriorated suddenly. Largeepiduralhematoma was revealed on CT, andsurgical treatment was performed promptly, but postoperative course was prolonged and with . severe psychosyndrome. The second patient, 9 years old boy,suffered moderate cerebral contusion and was alert, but agitated and dysoriented after trauma. Good improvement followedafter antidematous therapy, but after 7 days he deteriorated. Computed tomography showedepidural hematoma and urgentcraniotomy was performed. An excellentpostoperative recovery followed.
Chronic extradural hematoma: Report on 12 cases
C.U. Pereira, J.D.B.C. Leao, A.S. Barreto, A.D. Silva,A.FA Machado, D.M.O. Paixao. Department of Medicine, Federal University of Sergipe, Brazil The authors report twelve cases of chronic extradural hematoma. Eleven were treated surgically. We emphasize the value of CT in the diagnosis of these lesions,as well the indications for operation.
I P-2-175I
Monday, 7 July 1997
14:00-16:15
P-2 Head Injury - Outcome after Head Injury [P-2-176! Operative assessment of post-minor head injury syndrome-A P300 and blood flow velocity study K.C. Jain, AK Mahapatra, B.S. Walia. Department of Neurosurgery, Neuroscience CentreA.J.I.M.S., New Delhi·110029, India
R. Tadic, Z. Hoqanovlc, B. Antic. MilitaryMedicalAcademy, Department for Neurosurgery, Belgrade, Yugoslavia
I P-2-174!
Monday, 7 July 1997
Decompre~si.v~ craniectomy: a rare indication after severe brain Injury
M. Lorenz, E. Rickels, M. Zumkeller, M. Samii. Neurochirurgische Klinik, Medizinische Hochschule Hannover, 0-30623 Hannover, Germany Introduction: Some patients develop increasing intracranial pressures (ICP). that are not controllable with standardprocedures. A widelyopened dura and a decompressive craniectomy (DC) will augmentthe spacefor the swollenbrain and that may help in controllingICP and restoration of an adequate blood-flow. Patientsand methods: In 27 patientsa delayedDC was pertormed Within the last 10 years. All patients had a severely decreasing cerebral perfusion pressure and some had episodes of transient pupillary dilatation despite maximum therapy. The worsened hemodynamics could be seen by transcranial Doppler sonography. The bone flaps were preserved and reimplantated 3 weeks to 5 month later or a Palacosimplant was used. Results: After a decreasethe ICP increased in almostall cases in a second phase that could be successfully treated in most persons. 9 patients had a poor outcome. However, 5 patients showed a very good outcome, who would have definitely died without DC. Surviving patients will subsequently develop hygromas, which usuallyresolvewithouttherapy. Conclusion: The decompressive craniectomy experiences a revival withinthe last years. In our opinion. the ideal patient will fulfil the following prerequisites to have a hopeful prognosis. However, the minority of our cases matched all of these points: 1. SEP central transit time below 7 ms on at least one side; 2. no devastating and multiple lesionsin eloquentbrain. areas;3. ICP runs out of control secondarily; 4. age under 20 years.
Post-minor head injurysyndrome is a common and often a debilitating sequala following a minor head injury. This syndrome comprising mainly of persisting headache and dizziness is a completely subjective entity. We have tried to assessobjectively thesepatientsusingP300(aneventrelatedevokedpotential) and measurements of blood flow velocity (BFV) using transcranial doppler (TCD). In phaseI of our study65 patientswith post-minor head injury syndrome underwent a P300 study. 39 patients had mild symptoms, 14 had moderate while 12 had severe symptoms. Of these 23 had unilateral and 27 had bilateral delay of P300. The average delay of P300 was 388 msec. The P300 values correlated very well with the severity of symptoms. In phase II of our study we are evaluating the P300 values and BFV using TCD in these patients with minorheadinjuries. We haveso far evaluated 20 patients. Ratioof BFV in MCA to that in ICA was calculated in all these patients to differentiate hyperemia from vasospasm. 10 of these have a bilateral while B have unilateral delay of P300 while the BFV was normal in 10, increaseunilaterallyin 8 and bilaterally in 2 patients. Vasospasm was seen in one patient who showed contralateral hyperemia. All patients with an increased BFV had delayed P300. Increased BFV correlated well with the smallest parenchymal lesion seen on CT scan. Thus,our studyindicates that there is a goodcorrelation between the degreeof symptoms in post-minor headinjurypatientsand P300and bloodflow velocities.
IP-2-177!
Postoperative results after severe head injuries in children and adults. A comprehensive study
D. Kintzel, U. Meier, F.S. Zeilinger. Department of Neurosurgery, Hospital Berlin-Friedrichshain, Germany IntrOduction: In this studywe focusedour attention on the causes of the accident, the surgeon's reports, and the prognosis of severe head injuries suffered in children. We compared the causes for the different results of treatment in children and adults. Method: During a periodof 15years, 1123patientsunderwent operations for severehead injuries in our department. Of these 1123patients, 936 (83%)who had been classified into four diagnosed groups corresponding to their period of life, were evaluated using the GlasgowComa Scale and Glasgow Outcome Scale. ReSUlts: The resultsof treatment for severehead injuries in children did not displayexceptional differences compared withthe resultsfound in adults.Young patients with epidural hematomas and penetrating head injuries had a better prognosis than patients with acute subdural hematomas or brain contusions. Only the group of children with 6-8 points on the Glasgow Coma Scale upon admission to the hospital showed better results than the adults. The greater plasticity of the brain in childhood appears to be the reasonfor this. Conclusion: When analysing the course of disease in both children and adultswith severe head injuries, it was found that treatmentproduced different resultsdepending on the age of the patients.
I P-2-17S! Diffuse injury and age in severe closed head injury J. Pelaez, ~. Asensio. S. Yus, M. Sison, M.A. Arce, M. Jimenez. La Paz Hospital, Madrid, Spain Introduction: In orderto identifya subsetof patientswith majorrisk of mortality and morbidity following closed head injury, we analysed prospectively the outcome in relation to Computerized Tomography (CT) scan findings and patient age. Methods: FromJanuary-92 to March-96, 141 severe head trauma patients wereadmitted in our Neurosurgical Intensive Care Unit. Patientswereclassified in six arbitrary aged groups: 16-25 (n = 42),26-35 (n = 33), 36-45 (n = 22), 46-55 (n =15), 56-65 (n =10) and olderthan 65 years (n =19). For hte various age groups we recorded: initial CT findings according to the Traumatic Coma Data Bankand Glasgow OutcomeScore in each DiffuseInjury age groups. Results (see table): Diffuse Injury III was more frequent in patients aged 26-35 in relation to older than 65 (p < 0.01). When we compared the groups aged 26-35 and >65 the latter had more incidence of subdural hematoma and none had epidural hematoma (p < 0.01). Dead/vegetative were similar in
Head Injury - Outcome after Head Injury
patients (60.6%) died, two (6%) became vegetative, five (15.1%) developed a severedisabilityand six (18.t%) made a functional recovery. Patientsadmitted morethan 1 hour after trauma,those showingpupillary changes and those with shift, evacuated mass lesion or nonevacuated mass lesionon CT scanscorrelated with an unfavourable outcome.Only one of four patientswho underwent surgeryfor TBGHssurvived. Conclusion: Mortalitydue to TBGHs was 60.6%, higherthan overall mortality rate for SHls but the difference was not significant. TBGHs are dynamic lesions that tend to enlarge. Patients with hematoma volume greater than 25 cc had the worst prognosis and perhaps more aggressive surgical treatment shouldbe considered in them.
I P-2-173!
Delayed epidural hematomas
Delayed epidural hematoma (DEH) is rare clinical entity (about 40 cases reviewed from literature) which is characterized by clinicalpresentation three or more days after trauma. We present two young patients who developed DEH 7-12 days after primarytrauma, caused by trafficaccident. Thefirst patient, 11 years old boy,was somnolent immediately after trauma, and cerebral contusion was verified by computed tomography (CT).The patient recovered very well aftermedicamentous therapy, but after12 daysdeteriorated suddenly. Largeepiduralhematoma was revealed on CT, andsurgical treatment was performed promptly, but postoperative course was prolonged and with . severe psychosyndrome. The second patient, 9 years old boy,suffered moderate cerebral contusion and was alert, but agitated and dysoriented after trauma. Good improvement followedafter antidematous therapy, but after 7 days he deteriorated. Computed tomography showedepidural hematoma and urgentcraniotomy was performed. An excellentpostoperative recovery followed.
Chronic extradural hematoma: Report on 12 cases
C.U. Pereira, J.D.B.C. Leao, A.S. Barreto, A.D. Silva,A.FA Machado, D.M.O. Paixao. Department of Medicine, Federal University of Sergipe, Brazil The authors report twelve cases of chronic extradural hematoma. Eleven were treated surgically. We emphasize the value of CT in the diagnosis of these lesions,as well the indications for operation.
I P-2-175I
Monday, 7 July 1997
14:00-16:15
P-2 Head Injury - Outcome after Head Injury [P-2-176! Operative assessment of post-minor head injury syndrome-A P300 and blood flow velocity study K.C. Jain, AK Mahapatra, B.S. Walia. Department of Neurosurgery, Neuroscience CentreA.J.I.M.S., New Delhi·110029, India
R. Tadic, Z. Hoqanovlc, B. Antic. MilitaryMedicalAcademy, Department for Neurosurgery, Belgrade, Yugoslavia
I P-2-174!
Monday, 7 July 1997
Decompre~si.v~ craniectomy: a rare indication after severe brain Injury
M. Lorenz, E. Rickels, M. Zumkeller, M. Samii. Neurochirurgische Klinik, Medizinische Hochschule Hannover, 0-30623 Hannover, Germany Introduction: Some patients develop increasing intracranial pressures (ICP). that are not controllable with standardprocedures. A widelyopened dura and a decompressive craniectomy (DC) will augmentthe spacefor the swollenbrain and that may help in controllingICP and restoration of an adequate blood-flow. Patientsand methods: In 27 patientsa delayedDC was pertormed Within the last 10 years. All patients had a severely decreasing cerebral perfusion pressure and some had episodes of transient pupillary dilatation despite maximum therapy. The worsened hemodynamics could be seen by transcranial Doppler sonography. The bone flaps were preserved and reimplantated 3 weeks to 5 month later or a Palacosimplant was used. Results: After a decreasethe ICP increased in almostall cases in a second phase that could be successfully treated in most persons. 9 patients had a poor outcome. However, 5 patients showed a very good outcome, who would have definitely died without DC. Surviving patients will subsequently develop hygromas, which usuallyresolvewithouttherapy. Conclusion: The decompressive craniectomy experiences a revival withinthe last years. In our opinion. the ideal patient will fulfil the following prerequisites to have a hopeful prognosis. However, the minority of our cases matched all of these points: 1. SEP central transit time below 7 ms on at least one side; 2. no devastating and multiple lesionsin eloquentbrain. areas;3. ICP runs out of control secondarily; 4. age under 20 years.
Post-minor head injurysyndrome is a common and often a debilitating sequala following a minor head injury. This syndrome comprising mainly of persisting headache and dizziness is a completely subjective entity. We have tried to assessobjectively thesepatientsusingP300(aneventrelatedevokedpotential) and measurements of blood flow velocity (BFV) using transcranial doppler (TCD). In phaseI of our study65 patientswith post-minor head injury syndrome underwent a P300 study. 39 patients had mild symptoms, 14 had moderate while 12 had severe symptoms. Of these 23 had unilateral and 27 had bilateral delay of P300. The average delay of P300 was 388 msec. The P300 values correlated very well with the severity of symptoms. In phase II of our study we are evaluating the P300 values and BFV using TCD in these patients with minorheadinjuries. We haveso far evaluated 20 patients. Ratioof BFV in MCA to that in ICA was calculated in all these patients to differentiate hyperemia from vasospasm. 10 of these have a bilateral while B have unilateral delay of P300 while the BFV was normal in 10, increaseunilaterallyin 8 and bilaterally in 2 patients. Vasospasm was seen in one patient who showed contralateral hyperemia. All patients with an increased BFV had delayed P300. Increased BFV correlated well with the smallest parenchymal lesion seen on CT scan. Thus,our studyindicates that there is a goodcorrelation between the degreeof symptoms in post-minor headinjurypatientsand P300and bloodflow velocities.
IP-2-177!
Postoperative results after severe head injuries in children and adults. A comprehensive study
D. Kintzel, U. Meier, F.S. Zeilinger. Department of Neurosurgery, Hospital Berlin-Friedrichshain, Germany IntrOduction: In this studywe focusedour attention on the causes of the accident, the surgeon's reports, and the prognosis of severe head injuries suffered in children. We compared the causes for the different results of treatment in children and adults. Method: During a periodof 15years, 1123patientsunderwent operations for severehead injuries in our department. Of these 1123patients, 936 (83%)who had been classified into four diagnosed groups corresponding to their period of life, were evaluated using the GlasgowComa Scale and Glasgow Outcome Scale. ReSUlts: The resultsof treatment for severehead injuries in children did not displayexceptional differences compared withthe resultsfound in adults.Young patients with epidural hematomas and penetrating head injuries had a better prognosis than patients with acute subdural hematomas or brain contusions. Only the group of children with 6-8 points on the Glasgow Coma Scale upon admission to the hospital showed better results than the adults. The greater plasticity of the brain in childhood appears to be the reasonfor this. Conclusion: When analysing the course of disease in both children and adultswith severe head injuries, it was found that treatmentproduced different resultsdepending on the age of the patients.
I P-2-17S! Diffuse injury and age in severe closed head injury J. Pelaez, ~. Asensio. S. Yus, M. Sison, M.A. Arce, M. Jimenez. La Paz Hospital, Madrid, Spain Introduction: In orderto identifya subsetof patientswith majorrisk of mortality and morbidity following closed head injury, we analysed prospectively the outcome in relation to Computerized Tomography (CT) scan findings and patient age. Methods: FromJanuary-92 to March-96, 141 severe head trauma patients wereadmitted in our Neurosurgical Intensive Care Unit. Patientswereclassified in six arbitrary aged groups: 16-25 (n = 42),26-35 (n = 33), 36-45 (n = 22), 46-55 (n =15), 56-65 (n =10) and olderthan 65 years (n =19). For hte various age groups we recorded: initial CT findings according to the Traumatic Coma Data Bankand Glasgow OutcomeScore in each DiffuseInjury age groups. Results (see table): Diffuse Injury III was more frequent in patients aged 26-35 in relation to older than 65 (p < 0.01). When we compared the groups aged 26-35 and >65 the latter had more incidence of subdural hematoma and none had epidural hematoma (p < 0.01). Dead/vegetative were similar in