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Turkish Neurosurg 13 - Surgical Management of TISDH
Turkish Neurosurg 13 - Surgical Management of TISDH
Turkish Neurosurg 13 - Surgical Management of TISDH
DOI: 10.5137/1019-5149.JTN.8377-13.0
Hospital of Chinese Peoples Liberation Army, Department of Neurosurgery,Wu Xi, Jiang Su, China
University Hospital, Edegem, Belgium and University of Antwerp, Department of Neurosurgery, Antwerp, Belgium
2Antwerp
ABSTRACT
AIm: To review our experience in the surgical treatment of TISH, and to analyze prognostic factors.
MaterIal and Methods: Clinical and imaging data, surgical modalities, and outcomes of 21 patients with TISH who were treated with
microsurgery were analyzed retrospectively. Prognostic factors for outcome were analyzed by univariate analysis.
Results: Long-term follow up with outcome assessment according to the Glasgow Outcome Scale (GOS) showed good recovery in 16 cases,
moderate disability in two cases, severe disability in one case, and death in two cases. During surgery the origin of bleeding could be identified
in all 21 cases. A rupture of the distal anterior cerebral artery or veins in the interhemispheric fissure was seen more frequently in patients
with whole interhemispheric fissure hematoma, while hemorrhage from brain tissue laceration was seen more frequently in patients with
more localized hematomas. The outcome in patients with an identified rupture of a vessel was better than in those with cortical laceration.
Preoperative GCS score and thickness of the interhemispheric hematoma were correlated with outcome (P=0.001 and P=0.004, respectively).
ConclusIon: Outcome after surgical treatment for TISH can be good, and careful surgical planning and microsurgical techniques to preserve
venous drainage are essential.
Keywords: Traumatic interhemispheric subdural hematoma, Surgery, Outcome, Prognosis, Traumatic brain injury
Z
AMA: Travmatik interhemisferik subdural hematom cerrahi tedavisi konusunda deneyimimizi gzden geirmek ve prognostik faktrleri
analiz etmek.
YNTEM ve GERELER: Mikrocerrahi ile tedavi edilen 21 travmatik interhemisferik subdural hematom hastasnda klinik ve grntleme
verileri, cerrahi modaliteler ve sonular retrospektif olarak analiz edildi. Sonu iin prognostik faktrler tek faktrl analiz (univariate) ile analiz
edildi.
BULGULAR: Glasgow Sonu lei (GOS) uyarnca sonu deerlendirmesiyle uzun dnemli takip 16 olguda iyi bir iyileme, iki olguda orta
derecede malliyet, bir olguda iddetli malliyet ve iki olguda lm gsterdi. Cerrahi srasnda kanamann kayna 21 olgunun tmnde
tanmlanabildi. nterhemisferik fissrde distal anterior serebral arter veya venlerin rptr tam interhemisferik fissr hematomu olan hastalarda
daha skken, beyin dokusu laserasyonundan hemoraji daha lokalize hematomlar olan hastalarda daha skt. Tanmlanm damar rptr olan
hastalarda sonu kortikal laserasyonu olanlardan daha iyiydi. Preoperatif Glasgow Koma lei skoru ve interhemisferik hematom kalnl
sonula ilikiliydi (Srasyla P=0,001 ve P=0,004,).
SONU: Travmatik interhemisferik subdural hematom iin cerrahi tedavi sonrasnda sonu iyi olabilir ve venz drenaj korumak iin dikkatli
cerrahi planlama ve mikrocerrahi teknikler ok nemlidir.
ANAHTAR SZCKLER: Travmatik interhemisferik subdural hematom, Cerrahi, Sonu, Prognoz, Travmatik beyin yaralanmas
Introduction
Traumatic interhemispheric subdural hematoma (TISH) is
a rare clinical event in cases of traumatic brain injury (TBI),
and the literature is restricted to a small number of clinical
cases or individual case reports (1-2,4,5-9). One of the largest
series was reported by Takeuchi et al (9), who described the
results of conservative treatment in 35 cases with TISH and
reported a mortality rate of 29%. Controversy exists about
the management of TISH, and reports on outcomes after TISH
show mortality rates of 24% to 35% (2,6,9). To our knowledge
there are no large series reporting specifically on the results
228
Figure 2: Bilateral traumatic interhemispheric subdural hematoma before and after surgery. The 54-year female patient was injured
while riding a bicycle. A) Head computed tomography 38 hours after injury showed bilateral interhemispheric subdural hematoma.
Pre-operative Glasgow Coma Scale score was 11, with dysphasia. Muscle strength of the left lower extremity was grade I. B) The main
intra-operative intent was to remove the right hematoma. As the left hematoma was small, it was not surgically removed. The patients
language ability and muscle strength of the right lower extremity restored to a normal level 3 months after injury.
Turkish Neurosurgery 2014, Vol: 24, No: 2, 228-233
229
Age (y)
Gender: male
Glasgow Coma Scale score
8
9-12
13-15
Pupillary abnormalities
CT Findings
Unilateral
Bilateral
Interhemispheric fissure
Anterior
Posterior
Anterior + posterior
Associated ASDH
Traumatic subarachnoid hemorrhage
Surgery
Immediate
Delayed
Outcome
Unfavorable
Favorable
53 6.5
15 (71)
2 (10)
6 (28)
13 (62)
1 (5)
17 (81)
4 (19)
5 (24)
3 (14)
13 (62)
6 (28)
7 (33)
7 (33)
14 (67)
3 (14)
18 (86)
230
10
12
6
1
Discussion
Our experience in the treatment of patients with TISH shows
that careful surgical planning combined with the use of
231
Table III: Univariate Analysis of Prognostic Factors Related to Outcome in Patients with Traumatic Interhemispheric Subdural
Haematomas
Variable
Sex (M/F)
Age (y)
Mechanism of injury (fall/traffic accident)
GCS score
Falx syndrome
Time between injury and operation (h)
Mean hematoma volume (ml)
Mean hematoma thickness (mm)*
All patients
(n=21)
Favorable outcome
(n=18)
Poor outcome
(n=3)
P value
15/6
52.96.5
7/14
12.33.1
17
342.3
53.87.1
13.01.6
13/5
52.35.2
5/13
13.31.9
15
35.82.2
53.97.4
12.61.4
2/1
56.76.5
2/1
6.32.5
2
233.0
53.35.8
15.30.6
0.844
0.287
0.186
0.001
0.496
0.38
0.903
0.004
232
233