Di-san junyi daxue xuebao (Nov 2019)
Risk factors of hematoma enlargement in temporo-parietal lobe on impact side during contralateral decompressive surgery in patients with traumatic brain injury
Abstract
Objective To analyze the incidence and the risk factors of hematoma enlargement in the temporo-parietal region on the impact side during contralateral decompressive surgery in patients with contrecoup traumatic brain injury. Methods We retrospectively analyze the clinical data of 47 patients with traumatic brain injuries admitted in the Department of Neurosurgery of Chongqing Emergency Medical Center in 5 years (2013 to 2017). All the patients sustained brain injuries due to head impact in the temporo-parietal lobe and underwent contralateral hematoma evacuation surgeries. According to the changes in hematoma volume in the temporo-parietal region on the impact side during contralateral hematoma evacuation, the patients were divided into hematoma enlargement group and control group without hematoma enlargement. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for intraoperative hematoma enlargement from age, mechanism of trauma, Glasgow coma scale (GCS) score, pupillary reactivity, onset of preoperative shock, preoperative blood glucose, interval from brain injury to surgery, types and volume of hematoma on the impact side, skull fracture on the impact side, condition of the basal cistern, and midline shift. The outcomes of the patients in 6 months after the operation were compared between the 2 groups. Results Among all the cases, 10 (21.3%) patients showed enlarged hematoma in the temporo-parietal region on the impact side after contralateral decompressive surgery. Univariate analysis revealed that blood glucose, volume of hematoma and skull fracture on the impact side, and midline shift were significantly correlated with hematoma enlargement in the temporo-parietal region on the impact side. Logistic regression analyses identified skull fracture (OR=10.58) and hematoma volume on the impact side (OR=3.00) as the independent risk factors for hematoma enlargement on the impact side after contralateral hematoma evacuation. At 6 months after the operations, no significant differences were found in the outcomes of the patients between the 2 groups. Conclusion In patients with contrecoup brain injury with impact on the temporo-parietal lobe, a skull fracture on the impact side and a hematoma volume ≥10 mL are risk factors for hematoma enlargement in the temporo-parietal region on the impact side following contralateral decompressive surgery. The occurrence of such hematoma enlargement does not necessarily affect the patients' prognosis if it is timely detected with prompt treatment.
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