Surgical Management of Acute Subdural Hematoma (ASDH): Comparative Study between Duroplasty by Graft and Durotomy in A Tertiary Center

Abstract Background: Traumatic acute subdural hematoma is amongst the most dangerous and devastating type of head injuries. Clinically most patients present with Glasgow coma scale of 8 or lower. Clinically most patients present with Glasgow coma scale of 8 or lower. Aim of Study: The study is to evaluate the best surgical approach to deal with acute SDH and what are the prognostic factors affecting the best outcome. Patients and Methods: This is a retrospective study ex-amining 80 patients with acute subdural hematoma presenting into our Department of Neurosurgery in Beni Suef University and Kasr El-Aini from 2016 to 2022. 40 of which were operated upon by decompressive craniec-tomy and duroplasty and bone flap removal and placing the bone flap in the patient's abdominal wall and the other 40 were operated upon by decompressive craniotomy and dural snips. And not water tight fixation of the bone. Glasgow coma scale was used to assess conscious level before and after surgery and CT brain was the imaging method used in the initial diagnosis and the follow-up after surgery. Results: Results were divided into two groups: The first is the group in which decompressive craniotomy was paired with dural snips and the second in which it was paired with dural graft and removal of the bone flap and placing it in the patient's abdominal wall. Conclusion: We found in our study that pairing dural snips with craniotomy was better than dural graft and bone flap removal because of significant decrease in procedure time and blood loss and there was less post-operative rebound oedema with no apparent difference in the extent of removal of the hematoma the only drawback we had was in 5 patients in which there was active bleeding and the dural snips didn't give access to stop the bleeder in these cases we had to widen the dural excision and the dura was later closed with a graft but there was no need to remove the bone graft in conclusion in cases with no active bleeding we prefer the dural snips rather than the more extensive dural graft and bone flap removal.