Surgical management of persistent post-traumatic trans-tentorial brain hernia

Area of Science:

• Neurosurgery
• Traumatic Brain Injury Management
• Surgical Neurology

Background:

• Persistent temporal engagement can occur after acute subdural hematoma (ASH) surgery, even with normal intracranial pressure (ICP).
• This condition may persist without clinical improvement, necessitating further intervention.
• Assessing secondary direct temporal lobe disengagement (DTLD) is crucial for these cases.

Purpose of the Study:

• To evaluate the feasibility of secondary direct temporal lobe disengagement (DTLD) after supratentorial ASH surgery.
• To assess the clinical outcomes and safety of DTLD in patients with persistent temporal engagement.

Main Methods:

• Retrospective analysis of 4 patients who underwent secondary DTLD.
• Data collection included demographics, neurological scores (GCS, GOS-E), oculomotor nerve palsy (ONP), ICP, midline shift, and complications.
• Follow-up at 6 months post-DTLD.

Main Results:

• Significant improvement in Glasgow Coma Scale (GCS) scores (P=0.02) and midline shift (P=0.049) observed post-DTLD.
• Oculomotor nerve palsy (ONP) showed significant improvement (P=0.01), with 75% recovery at 6 months.
• 75% of patients achieved good recovery (GOS-E), with no surgery-related complications or mortality.

Conclusions:

• Secondary DTLD is a feasible, safe, and effective method for managing trans-tentorial uncal herniation in selected TBI patients.
• This technique avoids more complex procedures and shows promising results in improving neurological outcomes.
• DTLD favorably influences neurological outcomes in patients with persistent temporal engagement after ASH treatment.