• World Neurosurg · Nov 2023

    Acute Extra-Arachnoid Subdural Hematomas in the Cohort of Patients 50 Years and Older: When Subdurals Act Like Epidurals.

    • Jessica C Eaton, MeyerR MichaelRMDepartment of Neurological Surgery, University of Washington, Seattle, WA, USA., Do H Lim, Madeline E Greil, John R Williams, Christopher C Young, Jason K Barber, Nancy R Temkin, Robert H Bonow, and Randall M Chesnut.
    • Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
    • World Neurosurg. 2023 Nov 1; 179: e523e529e523-e529.

    BackgroundSome patients with subdural hematoma (SDH) with acute extra-arachnoid lesions and without concomitant subarachnoid blood or contusions may present in similarly grave neurological condition compared with the general population of patients with SDH. However, these patients often make an impressive neurological recovery. This study compared neurological outcomes in patients with extra-arachnoid SDH with all other SDH patients.MethodsWe compared a prospective series of extra-arachnoid SDH patients without subarachnoid hemorrhage or other concomitant intracranial injury with a Transforming Research and Clinical Knowledge in TBI control group with SDH only. We performed inverse probability weighting for key characteristics and ordinal regression with and without controlling for midline shift comparing neurological outcomes (Extended Glasgow Outcome Scale score) at 2 weeks. We used the Corticosteroid Randomization After Significant Head Injury prognostic model to predict mortality based on age, Glasgow Coma Scale score, pupil reactivity, and major extracranial injury.ResultsMean midline shift was significantly different between extra-arachnoid SDH and control groups (7.2 mm vs. 2.7 mm, P < 0.001). After weighting for group allocation and controlling for midline shift, extra-arachnoid SDH patients had 5.68 greater odds (P < 0.001) of a better 2-week Extended Glasgow Outcome Scale score than control patients. Mortality in the extra-arachnoid SDH group was less than predicted by the Corticosteroid Randomization After Significant Head Injury prognostic model (10% vs. 21% predicted).ConclusionsPatients with extra-arachnoid SDH have significantly better 2-week neurological outcomes and lower mortality than predicted by the Corticosteroid Randomization After Significant Head Injury model. Neurosurgeons should consider surgery for this patient subset even in cases of poor neurological examination, older age, and large hematoma with high degree of midline shift.Copyright © 2023 Elsevier Inc. All rights reserved.

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