Dural Fenestrations versus Duraplasty in Traumatic Acute SubduralHematoma

AbstractBackground: Patients with Acute Subdural Hematomas (ASDHs) have higher mortality and lower functional recoveryrates compared with those of other head-injured patients. Theoptimal surgical management of traumatic (ASDHs) is con-troversial.Aim of Study: Is to compare results of (ASDHs) managedwith: Group (A) dural fenestrations (multiple fenestrationsof the dura in a meshlike fashion and removing clots throughthe small dural openings that are left open, short operativetime, minimal manipulations of the brain. Group (B) duraplasty (by pericranium or fascia lata graft and close dura afterevacation of hematoma long operative time, more manipula-tions of the brain.Patients and Methods: A retrospective review of 81patients with traumatic ASDH were operated at the Depart-ments of Neurosurgery at Cairo and Fayoum Universitesduring the period from 2012-2015. These patients are dividedinto two groups: Group (A) 55 patients operated with duralfenestrations, (50 males and 5 females) median age 41 yearsold. On admission there were 32 patients with Glasgow ComaScale (GCS) scores of 3 to 5, 21 patients with GCS scores of 6 to 8, and 2 patients with GCS scores of 9 to 12. Operative time average 120 minutes. Group (B) 26 patients operated with duraplasty, (22 males and 4 females) median age 44 years old. On admission there were 19 patients with Glasgow Coma Scale (GCS) scores of 3 to 5, 6 patients with GCS scores of 6 to 8, and one patient with GCS scores of 9 to 12. Operative time average 180 minutes. Early surgical evacuation, decompression craniotomy, intensive care management to monitor intracranial pressure and follow-up Computed Tomography (CT) of the brain are done for all patients.Results: Group (A): 20 patient died in the hospital, 16survived with unfavorable outcome, and 19 survived withfavorable outcome. Group (B): 15 patient died in the hospital, 6 survived with unfavorable outcome, and 5 survived with favorable outcome.Conclusions: The present analysis of the data reveals thatdural fenestrations show good prognosis in decompressivecraniectomy regarding short operative time, minimal brainmanipulations compared to duraplasty, which appear in a significant low morbidity, good survival with unfavorableoutcome and good survival with favorable outcome.