Urgent Surgery for Contralateral Intracranial Hematoma Secondary to Decompressive Craniectomy performed for Severe Traumatic Brain Injury : A Report of Six Cases

Decompressive craniectomy is an effective method to reduce intracranial pressure in patients with severe traumatic brain injury (TBI). However, it induces contralateral intracranial hematomas as infrequent but severe complication. We report six patients with severe TBI who underwent consecutive contralateral surgery after decompressive craniectomy. We analyze causative factors for additional surgery, and refer to treatment strategy of this grave condition. Six patients consisted of four men and two women, and their average age was 54.3 years old. The initial craniectomy was performed to evacuate acute subdural hematoma (ASDH) in four patients or traumatic intracerebral hematoma (TICH) in two patients. All patients showed contralateral intracranial hematomas〔acute epidural hematoma (AEDH) in three patients, ASDH in three patients〕and underwent consecutive surgery. All had cranial fracture on the coup side. As for the outcome, only one was good outcome〔moderately disabled (MD) 〕, three patients were poor outcome〔severely disabled (SD), vegetative survival (VS) 〕, and two patients died. When there is skull fracture contralateral to the initial craniectomy side, it is likely that a contralateral hematoma will develop and will require additional surgery. In addition, the brain expansion toward the initial craniectomy site might be indirect finding caused by development of contralateral intracranial hematoma. Therefore, in severe TBI patients with both coup and contrecoup injuries, we suggest finishing the initial craniectomy as soon as possible, and immediately performing post-operative CT after the initial craniectomy. Timely bilateral surgeries might be able to improve outcome of these severe TBI patients.