Korean J Neurotrauma.  2012 Oct;8(2):79-86. 10.13004/kjnt.2012.8.2.79.

Analysis of Risk Factors for the Development of Post-Operative Epidural Hematoma after Intracranial Surgery

• Gu WM
• Joo WI
• Rha HK
• Park HK
• Chough CK
• Lee KJ

• KMID: 1427711
• DOI: http://doi.org/10.13004/kjnt.2012.8.2.79

Abstract

OBJECTIVE
Patients undergoing intracranial operations often suffer from post-operative epidural hematoma (EDH). The incidence and risk factors for with the occurrence of EDH after intracranial operations are not well described previously. The objective of this study was to identify the risk factors and the incidence of post-operative EDH adjacent and regional to the craniotomy.
METHODS
This was a retrospective study of 23 (2.4%) patients, between January 2005 and December 2011, who underwent epidural hematoma evacuation after primary intracranial during this period, 941 intracranial operations were performed. The control group (46 patients) and hematoma group (23 patients) were categorized on the basis of having undergone the same pre-operative diagnosis and treatment within 3 months of their operations. The ages of the hematoma and control group were individually matched to similar ages within 10 years of each other to minimize bias of age.
RESULTS
Univariate analysis showed that the significant pre-operative and intra-operative factors associated with post-operative EDH were a pre-operative Glasgow Coma Scale (GCS) scored <8 (crude odds ratio 8.295), prothrombin ratio >1.0 (p=0.014), prothrombin time (PT) >11.3 sec (p=0.008), intra-operative blood loss >650 mL (p=0.003) and craniotomy size >7,420 mm2 (p=0.023). In multivariate analysis, intra-operative blood loss exceeding 650 mL (median of total patients) placed a patient at significantly increased risk for post-operative EDH.
CONCLUSION
Recognizing the limitations of the study, large intra-operative blood loss, wide craniotomy area, prolonged PT and a pre-operative GCS <8 are presented implicated with an increased risk of post-operative EDH after intracranial surgery.

Keyword

Intracranial epidural hematoma; Post-operative hematoma; Craniotomy; Risk factor

MeSH Terms

Bias (Epidemiology)
Craniotomy
Glasgow Coma Scale
Hematoma
Hematoma, Epidural, Cranial
Humans
Incidence
Multivariate Analysis
Odds Ratio
Prothrombin
Prothrombin Time
Retrospective Studies
Risk Factors
Prothrombin

Figure

• 

  FIGURE 1. Results of computed tomography (CT) examinations. A: CT scan showing intracranial hematoma at right basal ganglia with midline shifting. B: Post-operative immediate brain CT scan showed almost completely removed intracerebral hemorrhage, and also showed large amount of epidural hematoma (EDH) with aggravated mass effect. C: After reoperation was performed to remove the EDH beneath the previous craniectomy site, brain CT scan showed no residual epidural hematoma. A marginal amount of intracerebral hemorrhage remained.

• 

  FIGURE 2. Data concerning craniotomy extent. Craniotomy extent was measured from plain lateral skull X-ray that is, from maximal perpendicular diameter (radius a and b) of the craniotomy. The resulting size of craniotomy was then approximated using the formular for a circle (size=π×ab).

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