A common dilemma in neurosurgery is whether to immediately replace the bone flap in the skull after surgical treatment of an acute subdural hematoma. AANS2023
LOS ANGELES ― A common dilemma in neurosurgery is whether to immediately replace the bone flap in the skull after surgical treatment of an acute subdural hematoma.
Hutchinson presented the findings from the Randomized Evaluation of Surgery With Craniectomy for Patients Undergoing Evacuation of Acute Subdural Hematoma trial at the annual meeting of the American Association of Neurological Surgeons 2023. The studyTraumatic subdural hematoma often requires surgical evacuation using either craniotomy or decompressive craniectomy.
After the clot was removed, patients were randomly assigned to undergo craniotomy or craniectomy. Those in the craniotomy group could later undergo decompressive craniectomy if needed. "At 12 months, death had occurred in 30.2% of the patients in the craniotomy group and in 32.2% of those in the craniectomy group; a vegetative state occurred in 2.3% and 2.8%, respectively, and lower or upper good recovery occurred in 25.6% and 19.9%," the researchers report.
Researchers evaluated cost data, Hutchinson said. It appears likely that craniotomy will be less expensive, since it avoids the second operation to replace the missing skull section, he said.
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