KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT MÁU TỤ NGOÀI MÀNG CỨNG CẤP TÍNH DO CHẤN THƯƠNG SỌ NÃO TẠI BỆNH VIỆN ĐA KHOA XANH PÔN VÀ CÁC YẾU TỐ TIÊN LƯỢNG

Abstract

Objectives: To evaluate and analyze factors associated with surgical outcomes in traumatic EDH. Materials and methods: A descriptive study of a series of clinical cases involving 64 patients underwent surgical treatment for traumatic EDH at Saint Paul General Hospital from January 2022 to August 2024. The treatment was individualized by calculating the surgical approach and craniotomy size to the hematoma size and clinical characteristics. Among these patients, 20 patients underwent a small craniotomy with a bone flap diameter of ≤ 5 cm. Result: The mean age was 28.17 ± 17.82 years, with 78.13% male patients. Traffic accidents were the primary cause (78.13%). Patients with a preoperative Glasgow Coma Scale (GCS) score ≤ 8 accounted for 15.63%, and 85.94% of patients underwent surgery within 24 hours post-injury. Good treatment outcomes (GOS score of 4-5) were observed in 93.75% of cases. Important clinical factors associated with poor outcomes included  preoperative GCS ≤ 8, and preoperative pupil dilation. A large hematoma volume causing a midline shift of ≥ 5 mm and brain herniation on CT scan also indicated a poorer prognosis. In the group with a craniotomy size ≤ 5 cm (average craniotomy size: 4.15 ± 0.66 cm): 100% of patients had a GCS > 8, an average hematoma width of 6.30 ± 1.01 cm, and an average hematoma volume of 33.91 ± 11.03 cm³. All patients in this group had a discharge GOS score of 5. Postoperative brain CT showed an average residual hematoma thickness of 3.99 ± 3.15 mm and an average midline shift of 0.40 ± 1.05 mm, statistically significantly lower compared to patients with a craniotomy > 5 cm. Conclusions: Due to the acute progression within the first hours following traumatic brain injury, epidural hematoma necessitates rapid emergency management and timely surgical intervention. Patient monitoring should pay particular attention to consciousness level (Glasgow Coma Scale) and other neurological signs present in the patient. In select EDH cases with favorable consciousness, moderate hematoma size, and a centrally located hemorrhage, a craniotomy ≤ 5 cm can be a viable approach to address EDH with favorable clinical and imaging outcomes. Individualize the treatment approach for each patient to achieve the best possible outcomes.