Background: Traumatic subdural hematoma is one of the severe injuries to brain with high mortality rates. Dural opening is often associated with brain herniation against the dural edges due to associated edema that would lead to venous infarction. Aim: The objective of this study is to describe a technical note that would allow fast and effective closure of the dura after hematoma evacuation via duraplasty with analysis of the safety and competency of the technique. Subjects and Methods: The fast-track technique was implemented in 15 successive cases with acute subdural hematoma where the fascia lata flap was prepared and sutured to the planned dural incision before opening the dura, which allowed fast and effective closure of the dura before brain herniation. Subdural bridges were planned by using Gelfoam to prevent venous compression. Analysis of the technique effectiveness was performed by the operative detection of brain herniation, as well as clinical and radiological follow-up of patients. Results: All patients had a Glasgow coma score (GCS) below six before the operation. Mean time from trauma to surgery was five hours. The dura could be effectively closed with no brain herniation in all cases. Nine patients survived (60%), where five of them ended up in a vegetative state. Of these two recovered and three continued in a persistent vegetative state. The mortality rate was 40%. Post-operative infarction was detected in post-operative imaging of four patients. Conclusion: The fast-track duraplasty technique is fast and effective in prevention of brain herniation during surgery with favorable clinical outcome in comparison with the poor and severely deteriorated preoperative clinical presentation. More studies to evaluate the impact of the technique on the survival rate are warranted.
Jiang, J.-Y., Xu, W., Li, W.-P., et al. (2005) Efficacy of Standard Trauma Craniectomy for Refractory Intracranial Hypertension with Severe Traumatic Brain Injury: A Multicenter, Prospective, Randomized Controlled Study. Journal of Neurotrauma, 22, 623-628. https://doi.org/10.1089/neu.2005.22.623
Cagetti, B., Cossu, M., Pau, A., Rivano, C. and Viale, G. (1992) The Outcome from Acute Subdural and Epidural Intracranial Haematomas in Very Elderly Patients. British Journal of Neurosurgery, 6, 227-231.
Celso, B., Tepas, J., Langland-Orban, B., et al. (2006) A Systematic Review and Meta-Analysis Comparing Outcome of Severely Injured Patients Treated in Trauma Centers Following the Establishment of Trauma Systems. Journal of Trauma, 60, 371-378.
Taussky, P., Hidalgo, E.T., Landolt, H. and Fandino, J. (2012) Age and Salvage Ability: Analysis of Outcome of Patients Older than 65 Years Undergoing Craniotomy for Acute Traumatic Subdural Hematoma. World Neurosurgery, 78, 306-311.
Foo, L.L., Chaw, S.H., Chan, L., Ganesan, D. and Karuppiah, R. (2017) Intractable Intraoperative Brain Herniation Secondary to Tension Pneumocephalus: A Rare Life-Threatening Complication during Drainage of Subdural Empyema. Brazilian Journal of Anesthesiology, 67, 655-658. https://doi.org/10.1016/j.bjan.2015.09.006
Bhat, A.R., Kirmani, A.R. and Wani, M.A. (2013) Decompressive Craniectomy with Multi-Dural Stabs—A Combined (SKIMS) Technique to Evacuate Acute Subdural Hematoma with Underlying Severe Traumatic Brain Edema. Asian Journal of Neurosurgery, 8, 15-20. https://doi.org/10.4103/1793-5482.110275
Elshanawany, A.M. and Essa, A.A. (2018) Traumatic Acute Subdural Hematoma: Treatment by Evacuation with Decompressive Craniotomy and Cranioplasty, Case Series and Surgical Outcome Analysis. OJMN, 8, 331-341.
Kwon, Y.S., Yang, K.H. and Lee, Y.H. (2016) Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome. Korean Journal of Neurotrauma, 12, 22. https://doi.org/10.13004/kjnt.2016.12.1.22
Adeleye, A.O. and Azeez, A.L. (2011) Decompressive Craniectomy Bone Flap Hinged on the Temporalis Muscle: A New Inexpensive Use for an Old Neurosurgical Technique. Surgical Neurology International, 2, 150.