Correlative Factors Of Expanding Brain Injury In Patients With Acute Traumatic Epidural Hematoma After Surgical Evacuation

?Objective?To investigate the risk factors,mechanism and treatment strategies of expanding regional brain injury(traumatic intracerebral contusion or hematoma)in patients with acute traumatic epidural hematoma(ATEDH)after surgical evacuation.?Methods?59 patients with epidural hematoma being complicated with traumatic regional brain injury and underwent surgical evacuation were chosen in our study;their clinical and CT imaging data were retrospectively analyze.The volume of intracranial hematoma was measured by 3D Slicer software,and hematoma progression was determined by hematoma enlargement?V?12.5 cm~3 or V2/V1?1.4[?V=postoperative hematoma volume(V2)-preoperative hematoma volume(V1)].Risk factors,mechanism and treatment strategies of patients with expanding regional brain injury after surgery were analyzed by univariate and multivariate Logistic regression analyses.?Results?1.After surgery,22 showed expanding regional brain injury,accounting for37.29%:9 occurred expanding intracerebral hematoma,2 of whom had died after conservative treatment and 2 had expanding intracerebral contusion and hematoma.11 happened expanding intracerebral contusion,3 of whom occurred delayed intracerebral hematoma adjacent to the area of ATEDH and 2 of whom had undergone secondary craniotomy and both of them recovered well.2.Univariate analysis showed that preoperative hyperglycemia(>9.1mmol/L),preoperative abnormal coagulation and decompressive craniectomy were the risk factors of expanding intracerebral contusion or hematoma after surgery(P<0.05).Multivariate Logistic regression analysis revealed that preoperative abnormal coagulation was an independent risk factor(OR=6.498,P=0.041,95%CI=1.076~39.253).?Conclusion?1.Expanding regional brain injury had high morbidity in patients with ATEDH after surgical evacuation,and 3D Slicer software can be used as a measurement tool of volume to judge the progression of intracranial hematoma.2.Preoperative abnormal coagulation significantly increased the risk of expanding intracerebral contusion or hematoma of patients with ATEDH after surgery.3.The condition and dynamic CT of patients with high-risk of expanding regional brain injury after surgery should be closly observed.The early second craniotomy can improve the prognosis of patients with expanding regional brain injury after surgery.?Objective? To explore the risk factors,mechanism and treatment strategies of secondary brain injury(cerebral hemorrhage or cerebral infarction and brain edema)adjacent to ATEDH after surgical evacuation.?Methods? 44 patients with ATEDH who underwent surgical evacuation were chosen in our study;their clinical and imaging data were retrospectively analyze.Secondary brain injury adjacent to ATEDH was defined by postoperative CT or MRI.The risk factors,mechanism and treatment strategies of secondary brain injury adjacent to ATEDH after surgery were analyzed by univariate and multivariate Logistic regression analyses.?Results? 1.After surgery,11 showed secondary brain injury adjacent to ATEDH,accounting for 25.0%: 3 occurred cerebral hemorrhage,one of whom was diagnosed as cerebral venous hemorrhage in the area of cortical vein drainage caused by traumatic cerebral venous circulatory disorder,6 had cerebral infarction and brain edema and 2 happened hemorrhagic cerebral infarction and brain edema.2 of 11 had undergone secondary craniotomy for decompressive craniectomy and internal decompression,and both of them had achieved satisfactory effect.2.The ROC curve analysis showed that the area under curve(AUC),the sensitivity,and the specificity of ROC curve of epidural hematoma with thickness 33.5 mm in patients with secondary brain injury adjacent to ATEDH after surgery respectively was 0.722,45.5%,and 90.9%.Univariate analysis showed that the incidence of secondary brain injury adjacent to ATEDH was higher in patients with epidural hematoma thickness ? 33.5 mm after surgery,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis revealed that epidural hematoma thickness ? 33.5 mm was an independent risk factor of secondary brain injury adjacent to ATEDH after surgery(OR=7.367,P=0.024,95%CI=1.298~41.797).?Conclusion? 1.Acute epidural hematoma thicknes 33.5 mm had predictive value for secondary brain injury adjacent to ATEDH after surgical evacuation,and patients withs epidural hematoma thicknes ? 33.5 mm had the increased risk of postoperative cerebral hemorrhage or cerebral infarction and brain edema after ATEDH evacuation.2.The mechanism of secondary brain injury adjacent to ATEDH after surgical evacuation was complicated,and the intracranial venous circulatory disorder had a non-negligible effect on its occurrence.3.Decompressive craniectomy was an effective treatment for postoperative massive cerebral infarction and brain edema,and early correct diagnosis and anticoagulation therapy were particularly important for patients with cerebral venous thrombotic infarction or hemorrhage after ATEDH evacuation.