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Journal of Trauma and Injury 2013;26(3):226-228.
The Use of Multiple Fenestrations of the Dura in Acute Traumatic Subdural Hematoma in Elderly
Jongtae Park, Jikwang Yun
Department of Neurosurgery, School of Medicine, Wonkwang University, Iksan, Korea. jtpark@wku.ac.kr
노인 급성 외상성 경막하출혈 환자에서 시행한 다발성 경막천공술의 이용
박종태, 윤지광
원광대학교 의과대학 신경외과학교실
Received: 6 August 2013   • Revised: 24 August 2013   • Accepted: 28 August 2013
Abstract
Elderly patients with acute subdural hematomas have higher mortality and lower functional recovery rates compared with those of other head-injured patients. Early and widely surgical decompression and active intensive care represent the best way to assist these patients. However, abrupt decompression of the hematoma can lead to brain disruption and secondary ischemia in the brain surrounding the craniectomy site. Acute brain swelling and brain extrusion, which take place shortly after decompression, can lead to a catastrophic situation during the operation due to the impossibility of appropriate closure of the dura and scalp. To avoid the deleterious consequences of disruption of brain tissue, we have adopted multiple fenestrations of the dura in a mesh-like fashion and gradual release of subdural clots through the small dural openings that are left open. This is especially important in cases in which there are massive amount of subdural hematomas with small parenchymal lesion and severe midline shifts in elderly patients. Further clinical experiences should be conducted in a more selected series patients to estimate the impact of this technique on morbidity and mortality rates.
Key Words: Elderly; Acute subdural hematoma; Dural fenestration; Decompression
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