Acute traumatic subdural hematoma: surgical management in the presence of cerebral herniation – a single-center series and multivariate analysis

Abstract Introduction Acute traumatic subdural hematoma (aSDH) is a severe disease. Especially in patients with additional signs of cerebral herniation surgical treatment is still controversially discussed. However, previously investigated patient populations were heterogeneous. We therefore performed an analysis of our institutional data in a large homogenous selection of patients with traumatic aSDH in order to analyze factors determining clinical outcome. Methods Between 2010 and 2014, 196 patients with aSDH underwent surgical treatment in our department. Information including patient characteristics, treatment modality, radiological features, and functional outcome were analyzed. Outcome was assessed according to the Glasgow Outcome Scale (GOS) at 6 months and was dichotomized into favourable (GOS 1-3) and unfavourable (GOS 4-5) outcome. Furthermore, a multivariate analysis was performed to identify independent predictors of functional outcome. Results Overall, 26% of patients with aSDH achieved favourable outcome. In further analysis, presence of unilateral or bilateral dilated pupils as sign of cerebral herniation were present in 47% of the included patients. In the multivariate analysis, age >70 years and the presence of cerebral herniation were significant prognostic predictors for unfavourable outcome in patients suffering from aSDH. However, 15% of patients with aSDH and signs of cerebral herniation achieved favourable outcome during follow-up. Conclusions We provide detailed data on patients suffering from aSDH and signs of cerebral herniation. Despite mydriasis, favourable outcome might be achieved in a significant number of patients. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time.