Evaluation of Early Decompressive Craniotomy in Patients with Postraumatic Acute Subdural Heamatoma

Background: Decompressive craniotomy (DC) is an effective method of managing rise in intracranial pressure (ICP). Acute subdural haematoma (SDH) is associated with increase in compartmental as well as generalized ICP. Objective: Evaluating the timing of surgical evacuation and decompressive craniotomy in patients with acute subdural hematoma. Patients Methods: Sixteen patients with unilateral subdural hematoma and midline shift more than 5 mms were operated in a year period with a large DC and duroplasty with hematoma evacuation. All had immediate post-operative scans and monthly for the 1st 3 months. Results: Results regarding age, Glascow Coma Score (GCS), Timing of surgery , complications, intensive care unit (ICU) stay, Hospital stay and Glascow Outcome Score(GOS) were reported and evaluated. Conclusion: Decompressive craniotomy is and effective method to control the raised ICP. Combining the surgical evacuation of SDH with DC helps to control the anticipated increase in intracranial pressure. It helps also to reduce the midline shift and subfalcine herniation. Controlling both the midline shift and intracranial pressure (ICP) improves the surgical outcome of acute SDH. Early surgery reduces the time during which the brain is subjected to high intracranial pressure. Thus early surgery within first twenty four hours further improves the outcome.