Evacuation of traumatic intracranial haematoma

Intracranial bleeding (blood clots) can be extradural, subdural or intracerebral, and they can be life threatening conditions that require urgent removal.

An extradural haematoma usually results from a tear in the middle meningeal artery and is almost always associated with a skull fracture.

A subdural haematoma results from bleeding from the veins between the brain and its outer layer, the dura. They can be acute, chronic or acute on chronic.

Intracerebral haematomas often occur in patients with high blood pressure, patients who are taking Warfarin and in patients with a bleeding intracranial aneurysm.

4 different surgical interventions are described: 1. Simple aspiration, 2. Craniotomy with open surgery, 3. Endoscopic evacuation, 4. Stereotactic aspiration.

Speciality Neurosurgery
Urgency urgent, emergency
Duration 1.5 to 3 h
Blood Loss 250 ml to 2 litres
Anaesthesia General Anaesthetic, +/- Local Anaesthetic
Anaesthesia II Local Anaesthetic, +/- Sedation
Procedures Arterial line, Urinary catheter, +/- Central line, Supine position, Cross-match Blood (2 units)
Pain moderate (+++)
Post-op Pain II Tablets, Injection (im, iv), +/- PCA
Hospital Stay 3 to 7 days
Full Recovery 1 week to 12 months
Additional Info Duration and extent of recovery and rehabilitation depends on the extent and severity of any damage to the brain.
More Information Paper by GJ Hankey in Stroke 2003
created by Dr James Jack

Specialities

Neurosurgery

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