[Emergency drainage of acute intracranial hematomas with unsterile conditions during computerized tomography]

From January 1979 to December 1993, we treated 761 patients with epidural (n = 184) or subdural (n = 577) haematomas. Twenty-six were subjected to emergency trepanation on the CT-table, since their condition was considered life-threatening. All fulfilled the following criteria: 1. Glasgow Coma Score below 9, 2. Progressive coma and/or progressive anisocoria and/or 3. Other signs of acute life risk correlating with an intracranial haematoma. Nine of these 26 patients died (3 out of a total of 17 with epidural and 6 out of a total of 9 subdural haematomas). In 5 cases the cause of death was brainedema, in 3 cases a multiorgan failure, and one pneumonia. None of the patients acquired an infection at the trepanationsite or elsewhere within the CNS. Twelve patients had postoperative complications (8 with epidural and 4 with subdural haematoma). These caused a prolongation of the average hospitalization period. Patients with uncomplicated follow-up were discharged after 17.6 +/- 4.2 days, as opposed to 44.8 +/- 15.7 days for complicated cases. Six months following discharge 8 of 17 patients with an epidural haematoma had reached stage 5 of the Glasgow Outcome Scale, 4 were in stage 4, 1 in stage 3, and 1 in stage 2. Three patients had died. None of the 9 patients with a subdural haematoma had reached stage 5. One patient had reached stage 4, 2 stage 2, while 6 patients had died.