Britt R H, Hamilton R D
Neurosurgery. 1978 May-Jun;2(3):195-200. doi: 10.1227/00006123-197805000-00001.
A series of 42 patients who had large decompressive craniotomies for acute subdural hematoma has been reviewed with regard to long term results. Postoperative mortality (within 30 days of surgery) was 36%. Delayed but related deaths accounted for an additional 19% mortality, for a total mortality of 55%. Fourteen patients (33%) were able to return home, but there was a significant morbidity in terms of intellectual impairment, hemiparesis, and dysphasia. Recommended management includes establishment of an adequate airway, intravenous administration of mannitol, and performance of an emergency computerized tomographic (CT) scan before operation. A large decompressive craniotomy is performed, with removal of the blood clot, establishment of hemostasis, patch-grafting of the dura, and removal of the bone flap to allow the edematous, swollen brain to expand away from the brain stem. The mortality and morbidity will probably always remain high because in the majority of the cases significant structural damage to the cortical and brain stem structures occurs at the time of the injury.
对42例行急性硬膜下血肿大骨瓣减压术的患者进行了长期随访。术后死亡率（术后30天内）为36%。延迟但相关的死亡又占19%的死亡率，总死亡率为55%。14名患者（33%）能够回家，但在智力障碍、偏瘫和失语方面存在明显的致残率。推荐的治疗措施包括建立通畅气道、静脉注射甘露醇以及术前进行急诊计算机断层扫描（CT）。实施大骨瓣减压术，清除血凝块，止血，硬膜修补移植，去除骨瓣以使水肿、肿胀的脑组织从脑干处膨出。死亡率和致残率可能永远居高不下，因为在大多数病例中，皮质和脑干结构在受伤时就已受到严重的结构性损伤。
