Object. Patients with acute subdural hematomas (ASDHs) have higher mortalit
y and lower functional recovery rates compared with those of other head-inj
ured patients. Early surgical decompression and active intensive care treat
ment represent, so far, the best way to assist these patients. Paradoxicall
y, one of the factors contributing to poor outcomes in cases of ASDHs could
be rapid surgical decompression, owing to the severe extrusion of the brai
n through the craniotomy defect in response to acute brain swelling. To avo
id the deleterious consequences of abrupt decompression of the subdural spa
ce with disruption of brain tissue, the authors have adopted a new surgical
technique for evacuation of ASDHs. This procedure consists of creating mul
tiple fenestrations of the dura (MFD) in a meshlike fashion and removing cl
ots through the small dural openings that are left open, avoiding the creat
ion of a wide dural opening and the disruption of and additional damage to
brain tissue.
Methods. Thirty-one patients (26 male and five female patients with a mean
age of 32.5 years) harboring ASDHs were treated using this method. On admis
sion there were 16 patients (51.5%) with Glasgow Coma Scale (GCS) scores of
3 to 5, 11 patients (35.5%) with GCS scores of 6 to 8, and four patients (
12.9%) with GCS scores of 9 to 12. Postoperative computerized tomography sc
ans of the brain revealed evacuation of more than 80% of the hematoma in 29
of 31 patients. The overall mortality rate in this group was 51.6%.
Conclusions. This preliminary report of a new surgical approach for patient
s who have sustained ASDHs should be considered to avoid abrupt disruption
of the brain and to allow the gradual and gentle release of subdural clots.
This is especially important in cases in which there are severe midline sh
ifts and a tight brain. Further clinical studies should be conducted in a m
ore selected series to estimate the impact of this new procedure on morbidi
ty and mortality rates.