The various factors negatively influencing on surgical treatment of isolated traumatic intracranial multiple hematoma
The number of patients with traumatic brain injury (TBI) varies in different countries, from 89 to 281 per 100,000 of population and is increasing annually (according to forecasts that will continue to grow). TBI is one of the leading causes of death and disability in the working age population, in the industrialized countries. The multiple hematoma is 0.74% of TBI, and 8-25% of intracranial hematomas. Multiplicity of surgical approaches of intracranial hematomas are fraught with contradictions and potential errors. All known principles of surgery hematomas doesn’t guarantee the positive result.
On this basis, the aim is to stady the peculiarities of the clinical course and to identify factors influencing the outcomes of surgery isolated traumatic intracranial multiple hematoma.
The retrospective analysis were performed, the reliability of the presented material is estimated using the method of parametric statistics. 188 medical records of patients with isolated traumatic brain injury (ITBI) were studied, who operated in various hospitals of Republic of Armenia. Intracranial multiple hematoma (IMH) consisted of two components having directly above one another in the two different intracranial spaces — epidural, subdural or intracerebral, and were detected at 16 patients. 10 patients were under the age of 60, and six — 60 and older. 3 groups of patients are divided on the basis of the stage of the clinical course of the head injury, which patients were adopted in. 5 (31,25%) were in the first group, they were adopted in the stage of subcompensation, 7 (43,75%)-in the second group, they adopted in the moderate decompensation stage, 4 (25%)-in the third group, adopted in the rough decompensation stage. In the preoperative period IMH was detected by CT scan at 6 (37,5%) patients. IMH was detected only during the operation at 10 (62.5%) patients. 6 patients with IMH have intracerebral hematoma (IH) and subdural hematoma (SH), 5 — epidural hematoma (EH) and intracerebral hematoma (IH), 5 — EH and SH. Some of the patients had been operated within 1-2 hours after receipt, the rest — 3-24 hours. 2 (28,6%) patients from the second group were re- operated. The negative outcome was in 5 (31.25%) patients, 4 (25%) of whom died at 1 (6.25%) discharged with rough neurological deficit. The negative outcome was 1 (20%) patients of the first group, 2 (28,6%) of the second, 1 (25%) of the third.
IMH is rare in surgery of isolated head injury (8.5% (16)), and has severe clinical course – there no patient in the clinical compensation on admission. The clinical course is severe at the elderly patients in the age group of 60 years and more (50% (2). The lethal outcome seems at every fourth patient with IMH. The exodus of IMH are more unfavorable in patients with intracerebral hematoma (40-50%). Cardiovascular diseases also negatively affect on outcomes of surgical treatment (75% (3) of IMH. In the preoperative period IMH was detected in 37.5% (6) cases, and in 62.5% (10) cases was detected only during the operation. Delayed operation due to various reasons more than for 2 hours after adminision negatively affect on the outcomes of surgical treatment IMH (25-100%).
Conclusions: CT scan detects IMH in cases less than 50%. IMH is detected during the operation in the most cases. There are many factors negatively affecting on the outcomes IMH, that are severe condition of patients admitted in different stages of clinical decompensation, cardiovascular diseases, lack of treatment in the pre-hospital period, delayed operation for more that 2 hours after receipt, intracerebral component of IMH, the cerebral and extracerebral complications, in particular, focus of encephalomalacia and pulmonary complications.
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