Американский Научный Журнал SURGICAL METHODS FOR TRAUMATIC INTRACRANIAL HEMATOMAS

34 American Scientific Journal № ( 31) / 20 19
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// Neu rosurg Focus, 2018. - Vol. 44 (1 -6):E3.

SURGICAL METHODS FOR TRAUMATIC INTRACRAN IAL HEMATOMAS

Hazratkulov Rustam Bafoevich
Doctor of Philosophy in medicine, scientific researcher
Republican Specialized Scientific and Practical Medical Center of Neurosurgery
Tashkent, Republic of Uzbekistan

Summary . 342 patients with traumatic intracranial hematomas were treated. Decompressive crani есtomy
was performed in 222 (64.9%), craniotomy in 120 (35.1%) patients. Postoperative complications were observed
in 28% of patients who underwent craniectomy and 23% of whom underwent craniotomy. Factors in the formation
of recurrent and delayed hematoma s were the age of the patients, the presence of fractures of the skull bones, a
large amount of hematoma. The most frequent among the complications were purulent -inflammatory, the cause of
which were penetrating traumatic brain injury, extensive wounds of the ex ternal covers of the skull, reduced
immunological protective properties of the body, infection. Liquorodynamic complications in the form of
dysresorbtive hydrocephalus (1.4%) and subdural hydroma (4.1%), were more often observed after decompressive
craniec tomy.
Key words: traumatic intracranial hematomas, early and late postoperative complications.

Actuality. Treatment of severe traumatic brain
injuryis relevant in modern medicine and has great
socio -economic importance [3,5]. A large number of
comp licatio ns and adverse outcomes remain after
surgical treatment of patients with head injury despite
advances in surgical treatment and intensive care. [6,4].
Postoperative mortality among patients with severe
traumatic brain injury and its complications is 28% -
35% [2]. To date, the justification of surgical tactics,
and the prediction of the outcomes of surgical treatment
of severe head trauma taking into account various risk
factors, is relevant [1].
Background: to study the early and late
complications a fter su rgical treatment of patients with
traumatic intracranial hematomas.
Methods. 342 patients with traumatic intracranial
hematomas were treated at the Republican Specialized
Scientific and Practical Medical Center of
Neurosurgery. The decompressive cra niectom y was
performed by 222 (64.9%) patients out of 342,
craniotomy - 120 (35.1%) patients.
Results and discussion. According to our
observations, early and late complications were
identified after surgical interventions. The first 3 -7 days
after surgery were a ttributed to early complications:
delayed and recurrent hematomas, development of
hemorrhagic foci of brain contusions requiring surgical
intervention. Late complications of 8 or more days
included purulent -inflammatory complications
(meningitis, ve ntricul itis, encephalitis, subdural
empyema), recurrent subdural hydromas, disresorbtive
hydrocephalus. Early intracranial complications
developed in patients with depression of the level of
wakefulness to deep coma on the Glasgow Coma Scale
(GCS) 4 -6 poin ts in 1 4.3% of 4.9% GCS 7 -8 points.
19 (8.6%) of 222 patients were operated on for
postponed and recurrent hematomas after wide
craniectomy. Sheath recurrent hematomas (subdural or
epidural) were diagnosed in 10 patients in the first two
days after wide c raniect omy. Moreover, in 9 patients
out of 10 repeated hematomas were found on the side
opposite to wide craniectomy. Most often, delayed and
recurrent hematomas were formed after removal of
acute subdural hematomas and multiple hematomas.
After removal of subacu te subdural hematomas,
epidural hematomas, traumatic intracerebral
hematomas, repeated hematomas were formed much
less frequently - in 1 -3% of cases. After craniotomy, 12
(10.0%) patients out of 120 were operated on for
delayed and recurrent hematom as. Of the 12 delayed
and recurrent hematomas in 11 (91.7%) patients, these
were recurrent hematomas in the area of surgery, in 2
patients hematomas were located on the opposite side
of operation. As well as after decompressive
craniectomy and after cran iotomy, the most frequently
delayed and recurrent hematomas were formed after
removal of acute subdural hematomas and multiple
hematomas, however, more often than after
craniotomy, repeated hematomas are formed after
removal of subacute subdural hematomas in 21% of
cases.
Age was one of the factors in the formation of
delayed hematomas. The age of patients who were
operated on for delayed hematomas ranged from 50 to
70 years. In the group of patients who had no delayed
hematomas, the age was 40 -55 years. Th us, mor e than
50% of patients who developed delayed hematomas
were older than 50 years. Among patients aged 60 years
and younger, recurrent hematomas were observed in
2.6%. Among patients older than 60 years, 12.3% of
patients had recurrent hematomas. Ofte n, the
development of recurrent hematomas in older patients
is due to an increase in free liquor spaces due to brain
atrophy, the admission of elderly patients with
anticoagulants. All patients who developed an epidural
hematoma on the side of the opposite operat ion had a
fracture of the cranial bones on the side of the
hematoma formation. Delayed hematomas were in

American Scientific Journal № ( 31) / 2019 35

patients with a large total amount of damage
(hemorrhagic component and the area of the brain
edema). The volume of damage in patients who
dev eloped delayed hematomas was 80 -120 cm 3,
without repeated hematomas, the volume was 50 -60
cm 3. The development of brain contusion foci,
accompanied by an increase in the volume of the dense
part and edema and requiring reoperation, occurred on
days 3 –5 after wide craniectomy and was detected in 15
(6.8%) patients from 222, 8.6% of repeated surgeries in
craniectomy. After craniotomy, repeated operations for
the development of brain contusions were performed in
3 (2.5%) of 120 patients and constitute 20% of all
repe ated operations after craniotomy.
Subdural hydromas were observed more
frequently after decompressive craniectomy. 9 (4.1%)
of the 222 patients who underwent craniectomy, were
subjected to surgical treatment for recurrent hydrom. In
78% of patients, the hy dromas were located on the side
of the trepanation, in 22% they were bilateral. In 7 out
of 9 patients, external drainage of the hydromere
through the bure hole was performed, in 2 (22.2%)
patients, ventriculoperitoneal shunting was performed.
Among patien ts who underwent craniotomy, surgical
treatment for recurrent subdural hydromas was
performed in 1 (1%).
Disresorbtive hydrocephalus was formed in 3
(1.4%), which was performed craniectomy. After
craniotomy, disresorbtive hydrocephalus was in 1
(0.83%). Ve ntriculoperitoneal shunting was performed
in all patients with dysresorbtive hydrocephalus.
Intracranial purulent -inflammatory complications
(meningitis, encephalitis, subdural empyema)
developed in 51 (23%) patients who underwent
craniectomy and in 10 (8. 3%) after craniotomy -120. A
large number of inflammatory complications were
caused by a combination of many factors: the presence
of penetrating head injury in patients, extensive wounds
of the external covers of the skull, reduced
immunological protective properties of the body, the
development of systemic inflammatory response
syndrome, the addition of infection. Conservative
treatment of purulent -inflammatory complications was
performed in 21 patients, re -operated - 4. 2 patients
were removed subdural em pyema, 1 - removal of brain
abscess, 1 - installation of external ventricular drainage
due to the development of ventriculitis.
Conclusions: Thus, postoperative complications
in patients with traumatic intracranial hematomas were
observed in 28% of patient s who underwent wide
craniectomy and in 23% of patients who underwent
craniotomy. Factors in the formation of recurrent and
delayed hematomas were the age of the patients, the
presence of fractures of the skull bones, a large amount
of hematoma. The most f requent among the
complications were purulent -inflammatory, the cause
of which were penetrating traumatic brain injury,
extensive wounds of the external covers of the skull,
reduced immunological protective properties of the
body, infection. Liquorodynamic complications in the
form of dysresorbtive hydrocephalus (1.4%) and
subdural hydroma (4.1%), were more often observed
after decompressive craniectomy.

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