Results of treatment of traumatic hematoma in patients one year after craniotomy

Forty consecutive patients who underwent cranial trepanation for traumatic hematoma after developing bilateral fixed dilated pupils were studied to determine factors affecting the quality of survival and to search for management criteria. Clinical data and computed tomography (CT) data correlated with the outcome 1 year after craniotomy. The functional recovery rate (good result or moderate disability) was 25%, and the mortality rate was 43%. Material and methods. Patients with subdural hematoma had a higher mortality rate (64%) compared to patients with epidural hematoma (18%) (chi-squared criterion, p > 0.05). Other factors associated with markedly increased morbidity and mortality were an increase in age (> 20 years), a long interval (> 3 hours) between loss of pupil reactivity and cranial trepanation, compression of basal cisterns and the presence of subarachnoid hemorrhage on computed tomography. Results. Among the patients who had any of the following symptoms, there were no survivors: surgery 6 hours or more after bilateral loss of pupil reactivity; age over 65 years; or lack of motor reaction. The results obtained indicate that the presence of an acute subdural hematoma is the single most important predictor of a negative outcome in patients with bilateral unresponsive pupils