Outcomes Similar With Craniotomy, Craniectomy for Subdural Hematoma

THURSDAY, April 27, 2023 (HealthDay News) -- For patients with traumatic acute subdural hematoma, disability and quality-of-life outcomes are similar with craniotomy (bone flap replaced) or decompressive craniectomy (bone flap not replaced), according to a study published online April 23 in the New England Journal of Medicine to coincide with the annual scientific meeting of the American Association of Neurological Surgeons, held from April 21 to 24 in Los Angeles.

Peter J. Hutchinson, Ph.D., from Addenbrooke's Hospital in Cambridge, England, and colleagues randomly assigned patients undergoing surgery for traumatic acute subdural hematoma to undergo craniotomy or decompressive craniectomy (228 and 222 patients, respectively). The primary outcome was the rating on the Extended Glasgow Outcome Scale (GOSE) at 12 months.

The researchers found that for the differences across GOSE ratings at 12 months, the common odds ratio was 0.85 (95 percent confidence interval, 0.60 to 1.18; P = 0.32). At six months, results were similar. Death had occurred in 30.2 and 32.2 percent of patients in the craniotomy and craniectomy groups, respectively, at 12 months; a vegetative state occurred in 2.3 and 2.8 percent, respectively; and a lower or upper good recovery was seen for 25.6 and 19.9 percent, respectively. At 12 months, EuroQol Group 5-Dimension 5-Level questionnaire scores were similar in the two groups. Within two weeks after randomization, additional cranial surgery was performed in 14.6 and 6.9 percent of the craniotomy and craniectomy groups, respectively. Wound complications were reported in 3.9 percent of the craniotomy group and 12.2 percent of the craniectomy group.

"In this trial involving adult patients undergoing evacuation of traumatic acute subdural hematoma, decompressive craniectomy and craniotomy yielded similar results with respect to overall outcomes at 12 months," the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

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