Search

Aim: To review our experience in the surgical treatment of TISH, and to analyze prognostic factors., Material and Methods: Clinical and imaging data, surgical modalities, and outcomes of 21 patients with TISH who were treated with microsurgery were analyzed retrospectively. Prognostic factors for outcome were analyzed by univariate analysis., Results: Long-term follow up with outcome assessment according to the Glasgow Outcome Scale (GOS) showed good recovery in 16 cases, moderate disability in two cases, severe disability in one case, and death in two cases. During surgery the origin of bleeding could be identified in all 21 cases. A rupture of the distal anterior cerebral artery or veins in the interhemispheric fissure was seen more frequently in patients with whole interhemispheric fissure hematoma, while hemorrhage from brain tissue laceration was seen more frequently in patients with more localized hematomas. The outcome in patients with an identified rupture of a vessel was better than in those with cortical laceration. Preoperative GCS score and thickness of the interhemispheric hematoma were correlated with outcome (P=0.001 and P=0.004, respectively)., Conclusion: Outcome after surgical treatment for TISH can be good, and careful surgical planning and microsurgical techniques to preserve venous drainage are essential.

Aim: Fast direct decompression surgery for treatment of severe head injury often results in intraoperative and postoperative complications. Controlled decompression may help prevent these complications. This preliminary study aims to compare the effects of controlled and conventional decompression in patients with severe head injury., Material and Methods: A total of 128 patients with severe head injury were included. Patients were allocated to receive either controlled decompression surgery (n = 64) or conventional decompressive craniectomy (n = 64). Controlled decompression comprised controlled ventricular drainage and controlled hematoma evacuation. The occurrence of delayed hematoma, acute brain swelling, and postoperative cerebral infarction were recorded., Results: Significantly lower proportion of patients in the controlled decompression group had intraoperative acute brain swelling compared to patients in the decompressive craniectomy group (9.4% vs 26.6%, P = 0.011). Intraoperative acute encephalocele occurred in 3 of 13 patients (23.1%) who had delayed hematoma in the controlled decompression group compared with 11 of 18 patients (61.1%) in the decompressive craniectomy group. There was no significant between group difference in the incidence of delayed hematoma or postoperative cerebral infarction., Conclusion: Controlled decompression may reduce or delay intraoperative acute brain swelling by delaying hematoma formation in patients with severe head injury.