127 CASES OF ACUTE SUBDURAL-HEMATOMA OPERATED ON - CORRELATION BETWEEN CT SCAN FINDINGS AND OUTCOME

Traumatic acute subdural haematoma is one of the most lethal of all he ad injuries: the mortality rate is reported to be between 50 and 90%. We reviewed the clinical records of 1688 head injured patients admitte d to the Department of Neurosurgery at C.T.O. hospital between 1982 an d 1992. In 127 cases (7,5%) CTscan on admission showed acute subdural haematoma requiring surgery because the midline shift was greater than 5 mm. The overall mortality rate was 57% and 23% had functional recov ery. The following variables were assessed with regard to morbidity an d mortality: mechanism of injury, age, neurological presentation, time delay from injury to intervention, CTscan finding on admission. GCS a nd CTscan findings were found to be the most important prognostic vari able. Timing of operative intervention for clot removal with regard to outcome was not statistically significant. But no conclusions regardi ng the importance of early haematoma evacuation can be drawn from such an oversimplifying statement, because it does not take into account f actors like rapidity of haematoma development and related brain decomp ensation as well as additional direct brain lesions. The results of th is study suggest that the extent of primary brain injury underlying th e subdural haematoma is the most important factor affecting outcome.