ONE-YEAR OUTCOME FOLLOWING CRANIOTOMY FOR TRAUMATIC HEMATOMA IN PATIENTS WITH FIXED DILATED PUPILS

Forty consecutive patients who underwent craniotomy for traumatic hema toma after developing bilateral fixed dilated pupils were studied to d etermine the factors influencing quality of survival and to seek crite ria for management. Clinical and computerized tomography (CT) data wer e correlated with outcome 1 year after craniotomy. The functional reco very (good outcome or moderate disability) rate was 25%, with a mortal ity rate of 43%. Patients with subdural hematoma had a higher mortalit y rate (64%) compared to patients with extradural hematoma (18%) (chi- square test, p > 0.05). Other factors associated with markedly increas ed morbidity and mortality were increasing age (> 20 years), a prolong ed interval (> 3 hours) between loss of pupillary reactivity and crani otomy, compression of basal cisterns, and presence of subarachnoid hem orrhage on CT. There were no survivors among patients exhibiting any o f the following features: surgery 6 hours or more after bilateral loss of pupillary reactivity; age greater than 65 years; or absent motor r esponse. Apart from the latter group, the nature of motor response (be fore pharmacological paralysis and intubation) was not a reliable pred ictor of mortality. The results suggest that the presence of an acute subdural hematoma is the single most important predictor of negative o utcome in patients with bilateral unresponsive pupils.