Radiological prediction of contralateral extradural haematoma following evacuation of traumatic acute subdural haematoma.

Autor:	Crinnion W; Department of Neurosurgery, The Royal London Hospital, London, UK., Doke T; Department of Neurosurgery, The Royal London Hospital, London, UK., Yordanov S; Department of Neurosurgery, The Royal London Hospital, London, UK., Moffat D; Department of Neurosurgery, The Royal London Hospital, London, UK., O'Halloran PJ; Department of Neurosurgery, The Royal London Hospital, London, UK., Mckenna G; Department of Neurosurgery, The Royal London Hospital, London, UK., Offiah C; Department of Neuroradiology, The Royal London Hospital, London, UK., Uff C; Department of Neurosurgery, The Royal London Hospital, London, UK.
Jazyk:	angličtina
Zdroj:	British journal of neurosurgery [Br J Neurosurg] 2024 Apr; Vol. 38 (2), pp. 367-371. Date of Electronic Publication: 2021 Feb 11.
DOI:	10.1080/02688697.2021.1877612
Abstrakt:	Objectives: To identify radiological predictors of contralateral extradural haematoma (CEDH) in patients undergoing evacuation of acute subdural haematoma (ASDH). Design: Retrospective case-control study. Subjects: Patients requiring evacuation of traumatic ASDH via craniotomy/craniectomy with contralateral skull fracture were analysed in two groups: those who developed CEDH postoperatively and those who did not. Materials and Methods: Retrospective analysis of severe traumatic brain injury admissions over 24 months (2017-2019) at a major trauma centre. Pre- and post-operative CT scans were reviewed by a Consultant Neuroradiologist for initial fracture haematoma (FH) and specific contralateral skull fracture features (CLFF) comprising: complex petrous fracture, suture diastasis and fractures involving foramen spinosum or middle meningeal groove (MMG). Results: 35 patients had ASDH evacuation (age: 11-74); 7 with craniotomy, 28 with craniectomy. 9/35 developed CEDH of whom 7 underwent bilateral craniotomy/craniectomy. 8/9 with CEDH had FH, 6/26 of those without CEDH had FH. All patients with CEDH had CLFF. 6/9 had >1 CLFF. CLFF was identified in 9/26 patients without CEDH and only 3/26 non-CEDH had >1 CLFF. Analysis using univariate logistic regression identified statistically significant factors for the development of CEDH which were: younger age, FH on initial CT, increasing number of CLFF and MMG involvement alone. After multivariate analysis, only younger age and FH were significant. Conclusions: FH and CLFF on CT enable prediction of CEDH in patients undergoing evacuation of traumatic ASDH. These features raise a high index of suspicion for this complication and may expedite investigation and management for CEDH.
Databáze:	MEDLINE
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