Brain injury, hemorrhage Op indication

Management Options for Traumatic Hemorrhagic Lesions

Condition                                                               Management

Subdural Hematoma
>10 mm thick or >5 mm midline shift	Surgical evacuation
ICP >20 mm Hg	Surgical evacuation
GCS score <9	ICP monitoring
Epidural Hematoma
>30 mL volume, regardless of GCS score	Surgical evacuation
GCS score >8 without focal neurological deficit	Conservative management with intensive monitoring and serial imaging
Intraparenchymal Hematoma
Progressive neurological deterioration referable to lesion, medically refractory intracranial hypertension, or mass effect on CT	Surgical evacuation
Any lesion >50 mL	Surgical evacuation
cisternal compression on CT	Surgical evacuation
no significant signs of mass effect on CT	Conservative management with intensive monitoring and serial imaging

 

CT, computed tomography; GCS, Glasgow Coma Scale; ICP, intracranial pressure.

 

 

 

• depressed skull Fx.에서 SSS 를 침범하였을 때 치료원칙

* Closed wound without any neurological defict , mass effect : observation  * Open wound with or without mass effect : filling defect -> decompression and wound closure 하고 observation  * Occlusion without any neurological deficit : sinus ligation and bone removal  * Normal sinus : bone removal with active therapy

 

 

EDH

 

 

SDH

 

 

ICH

 

 

 

 

Ref. Zacko, J. C., L. Harris, and M. R. Bullock. "Surgical management of traumatic brain injury." Youmans Neurological Surgery. Volume 4